Patterns of Recovery of Posttraumatic Confusional State in Neurorehabilitation Admissions After Traumatic Brain Injury

Abstract 

Sherer M, Yablon SA, Nakase-Richardson R. Patterns of recovery of posttraumatic confusional state in neurorehabilitation admissions after traumatic brain injury.

Objective

To provide preliminary descriptions of patterns of resolution of symptoms of acute confusion after traumatic brain injury (TBI).

Design

Prospective, descriptive, cohort study.

Setting

Inpatient neurorehabilitation unit.

Participants

Patients (N=107) meeting criteria for posttraumatic confusional state at admission to inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measure

Patterns of resolution of posttraumatic confusional state symptoms over the first 3 confusion assessment protocol evaluations for patients with mild, moderate, and severe confusion.

Results

Posttraumatic confusional state symptoms resolving earliest were psychotic-type symptoms, decreased daytime arousal, and nighttime sleep disturbance. Fluctuation and cognitive impairment were the 2 most persistent symptoms. Seventy-three percent of patients showed improvement of 1 or more symptoms from the first to third evaluation. Confusion severity groups did not significantly differ on indices of injury severity (Glasgow Coma Scale score, time to follow commands) but did differ on functional status at discharge from inpatient rehabilitation.

Conclusions

While posttraumatic confusional state is a heterogeneous disorder, there is a predictable pattern of symptom resolution. Differences in patients' confusion severity and patterns of symptoms may relate to differing underlying neural injury.

Key Words: Brain injuries, Confusion, Rehabilitation

List of Abbreviations: CAP, Confusion Assessment Protocol, DRS, Disability Rating Scale, GCS, Glasgow Coma Scale, LOS, length of stay, PTA, posttraumatic amnesia, TBI, traumatic brain injury, TBIMS, Traumatic Brain Injury Model Systems