MEASUREMENT AND TREATMENT OF AGITATION FOLLOWING TRAUMATIC BRAIN INJURY .2. A SURVEY OF THE BRAIN INJURY SPECIAL INTEREST GROUP OF THE AN-ACADEMY-OF-PHYSICAL-MEDICINE-AND-REHABILITATION

Objective: Determine national patterns of measuring and treating agita tion after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors. Design: A 70% random sample of me mbers of the Brain Injury Special interest Group of the American Acade my of Physical Medicine and Rehabilitation was surveyed by telephone. Main Outcome Measure: The survey instrument was designed to determine the most common pharmacologic interventions for agitation and, where p ossible, match each drug with the target behavioral and cognitive char acteristics for which it is prescribed. Data were also collected on th e manner in which participants measured agitation and judged treatment efficacy. Results: One hundred twenty-nine of 157 responded, yielding an 82% response rate. The majority of respondents were not measuring agitation in a standard fashion. The five most frequently prescribed d rugs by the expert stratum were carbamazepine, tricyclic antidepressan ts (TCAs), trazodone, amantadine, and beta-blockers. In comparison, th e nonexperts most often reported prescribing carbamazepine, beta-block ers, haloperidol, TCAs, and benzodiazepines. Desyrel (p = .06) and ama ntadine (p = .001) were significantly mon likely to be chosen by exper ts than by nonexperts. Experts chose haloperidol significantly less of ten than nonexperts (p = .01). Prescription of sedating drugs such as haloperidol or benzodiazepines was not found to be associated with the acuity of injury of TBI patients in the respondent's practice, practi ce setting, or years of practice since completing residency. Choice of haloperidol to treat agitation was not significantly associated with the degree to which explosive anger, verbal aggression, or physical ag gression were considered important to the respondent's definition of a gitation. Conclusions: The majority of physiatrists surveyed did not f ormally measure agitation. Treatment strategies differ significantly b etween general physiatrists and those who specialize in the treatment of patients with TBI. The breadth of pharmacologic agents and strategi es identified in this survey probably reflects the lack of research sp ecific to the pathophysiology of the disorder of posttraumatic agitati on. (C) 1997 by the American Congress of Rehabilitation Medicine and t he American Academy of Physical Medicine and Rehabilitation.