Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)
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(2020) 6:193
RESEARCH
Open Access
Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT) David R. Williamson1,2,3* , Sofia Ihsenne Cherifa1,2, Anne Julie Frenette1,2,3, Mar Saavedra Mitjans1,2, Emmanuel Charbonney2,4,5, Gabrielle Cataford1,2, Virginie Williams2, Julia Lainer Palacios2, Lisa Burry6,7, Sangeeta Mehta8, Caroline Arbour2,9, Francis Bernard2,4,5 and for the Canadian Critical Care Trials Group
Abstract Background: Agitated behaviors are problematic in intensive care unit (ICU) patients recovering from traumatic brain injury (TBI) as they create substantial risks and challenges for healthcare providers. To date, there have been no studies evaluating their epidemiology and impact in the ICU. Prior to planning a multicenter study, assessment of recruitment, feasibility, and pilot study procedures is needed. In this pilot study, we aimed to evaluate the feasibility of conducting a large multicenter prospective cohort study. Methods: This feasibility study recruited adult patients admitted to the ICU with TBI and an abnormal cerebral CT scan. In all patients, we documented Richmond Agitation Sedation Score (RASS) and agitated behaviors every 8-h nursing shift using a dedicated tool documenting 14 behaviors. Our feasibility objectives were to obtain consent from at least 2 patients per month; completion of screening logs for agitated behaviors by bedside nurses for more than 90% of 8-h shifts; completion of data collection in an average of 6 h or less; and obtain 6-month follow-up for surviving patients. The main clinical outcome was the incidence of agitation and individual agitated behaviors. Results: In total, 47 eligible patients were approached for inclusion and 30 (64% consent rate) were recruited over a 10-month period (3 patients/month). In total, 794 out of 827 (96%) possible 8-h periods of agitated behavior logs were completed by bedside nurses, with a median of 24 observations (IQR 28.0) per patient. During the ICU stay, 17 of 30 patients developed agitation (56.7%; 95% CI 0.37–0.75) defined as RASS ≥ 2 during at least one observation period and for a median of 4 days (IQR 5.5). At 6 months post-TBI, among the 24 available patients, an unfavorable score (GOS-E < 5 including death) was reported in 12 patients (50%). In the 14 patients who were alive and available at 6 months, the median QOLIBRI score was 74.5 (IQR 18.5). (Continued on next page)
* Correspondence: [email protected] Institution: The work was performed at Sacré-Coeur Hospital in Montreal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l’îlede-Montréal, Canada. 1 Faculté de Pharmacie, Université de Montréal, Montréal, Canada 2 Research centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l’île-de-Montréal, Montréal, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License
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