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22 Pharmacological treatment of agitation in acute traumatic brain injury: a service evaluation of prescribing at the walton centre
  1. Lori Black,
  2. Antonio Da Costa,
  3. Jon Smith,
  4. Lindsay Cleary,
  5. Vijay Sahitya
  1. The Walton Centre, Liverpool, UK

Abstract

Objectives A diverse range of medications are used to treat agitation in patients presenting with acute Traumatic Brain Injury (TBI). A service evaluation was conducted at The Walton Centre, a regional neuroscience centre to establish which psychopharmacological agents were being used most frequently in patients admitted with acute TBI.

Methods 187 patients were admitted with an acute TBI between April 2020 and July 2021. The notes of these patients were audited to find out their demographic details, the nature of their injuries, the surgical interventions they received and pre-morbid medical and mental health diagnoses. We then collated information on medications they were prescribed during their acute admission with a focus on analgesia, antiepileptics, benzodiazepines, antidepressants, antipsychotics, mood-stabilisers and melatonin. The data was then analysed.

Results 187 patients were admitted to the Walton Centre with an acute traumatic brain injury between April 2020 and June 2021. 127 (68%) of these patients were male and 60 (32%) female. 17 patients died as a result of their injuries, 99 were discharged home and the remainder were transferred to other hospitals for ongoing rehabilitation following their acute admission.

24.6% (n=46) of patients had a premorbid diagnosis of a mental disorder. Of these, 25 (54%) had a diagnosis of major depressive disorder and 23 (50%) an anxiety disorder. 11 patients had premorbid psychotic disorders, including 5 patients with schizophrenia, 2 with Bipolar Affective Disorder and 4 with other psychotic disorders with an unspecified diagnosis. 39 (20.9%) patients had a history of substance misuse. 87.1% (n=34) of these patients consumed alcohol to excess.

29.9% (n=56) of patients were prescribed an antidepressant. Of these, trazadone was used most frequently accounting for 35.7% (n=20) of antidepressant prescriptions. Mirtazapine was used in 10 patients and sertraline in 13. 30 patients (16%) were treated with an antipsychotic. Of these, 80% (n=24) of patients were given atypical antipsychotics whilst 26.7% (n=8) were prescribed typical antipsychotics. Olanzapine accounted for 56.6% (n=17) of antipsychotic prescriptions. 13.9% (n=26) of patients were prescribed melatonin, which was the most frequently used medication for sleep regulation.

Conclusions Patients admitted with TBI commonly had premorbid mental health diagnoses. Around 30% required pharmacological treatment for neuropsychiatric symptoms, with antidepressants, antipsychotics and mood-stabilising anti-epileptics being commonly used.

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