DEFINITION OF AGITATION FOLLOWING TRAUMATIC BRAIN INJURY .1. A SURVEYOF THE BRAIN INJURY SPECIAL INTEREST GROUP OF THE AN-ACADEMY-OF-PHYSICAL-MEDICINE-AND-REHABILITATION

Objective: To determine national patterns of defining agitation after traumatic brain injury (TBI) by physiatrists with expressed interest i n treating TBI survivors. Design: A random sample of 70% of the member s of the. Brain Injury Special Interest Group (SIG) of the American Ac ademy of Physical Medicine and Rehabilitation (AAPM&R) were surveyed b y telephone. Results: The 129 members who responded yielded an 82% res ponse rate. Respondents rated 18 characteristics from established rati ng scales on a 5-point scale according to each characteristic's relati on to its clinical definition of agitation. Physical aggression, explo sive anger, increased psychomotor activity, impulsivity, verbal aggres sion, disorganized thinking, perceptual disturbances, and reduced abil ity to maintain or appropriately shift attention were rated by at leas t 50% of the sample as very important or essential to agitation. Delir ium, as defined in the Diagnostic and Statistical Manual of Mental Dis orders (DSM), has been proposed as a standard definition of agitation. The degree to which all characteristics from the 3rd revised edition of the DSM (DSM-IIIR), considered together, were perceived to relate t o agitation predicted 24% of the degree to which the term ''delirium'' was perceived to relate to agitation (Canonical correlation r = .48, p = .0002). Physicians' ratings of individual delirium characteristics from the DSM-IIIR were examined to determine if a sufficient number w ere similarly ranked to fulfill the diagnostic criteria for delirium. A significant number of physicians rated diagnostic criteria for delir ium in one direction, yet did not rank the term ''delirium'' according ly (McNemar's p = .04). Conclusions: There is considerable variation a mong physiatrists in their rating of characteristics that define agita tion. Many define agitation during the acute recovery phase as posttra umatic amnesia plus an excess of behavior such as aggression, disinhib ition, and/or emotional lability. Less support was given to defining a gitation by the DSM-IIIR or DSM-IV diagnostic criteria for delirium. D elirium appears related to, but is not sufficient for, a diagnosis of agitation. (C) 1997 by the American Congress of Rehabilitation Medicin e and the American Academy of Physical Medicine and Rehabilitation.