Research Reports - Pharmacological interventions for agitation in patients with traumatic brain injury

Syst Rev. 2016 Nov 17;5(1):193.

Williamson DR(1,)(2), Frenette AJ(3,)(4), Burry L(5,)(6), Perreault MM(4,)(7),

Charbonney E(8,)(9), Lamontagne F(10,)(11), Potvin MJ(12,)(13), Giguère
JF(9,)(14), Mehta S(15,)(16), Bernard F(8,)(9).

BACKGROUND: Traumatic brain injury (TBI) is a worldwide leading cause of
mortality and disability. Among TBI complications, agitation is a frequent
behavioural problem. Agitation causes potential harm to patients and caregivers,
interferes with treatments, leads to unnecessary chemical and physical
restraints, increases hospital length of stay, delays rehabilitation, and impedes
functional independence. Pharmacological treatments are often considered for
agitation management following TBI. Several types of agents have been proposed
for the treatment of agitation. However, the benefit and safety of these agents
in TBI patients as well as their differential effects and interactions are
uncertain. In addition, animal studies and observational studies have suggested
impaired cognitive function with the use of certain antipsychotics and
benzodiazepines. Hence, a safe and effective treatment for agitation, which does
not interfere with neurological recovery, remains to be identified.
METHODS/DESIGN: With the help of Health Sciences librarian, we will design a
search strategy in the following databases: PubMed, Ovid MEDLINE®, EMBASE,
CINAHL, PsycINFO, Cochrane Library, Google Scholar, Directory of Open Access
Journals, LILACS, Web of Science, and Prospero. A grey literature search will be
performed using the resources suggested in CADTH's Grey Matters. We will include
all randomized controlled, quasi-experimental, and observational studies with
control groups. The population of interest is all patients, including children
and adults, who have suffered a TBI. We will include studies in which agitation,
not further defined, was the presenting symptom or one of the presenting
symptoms. We will also include studies where agitation was not the presenting
symptom but was measured as an outcome variable and studies assessing the safety
of these pharmacological interventions in TBI patients. We will include studies
evaluating all pharmacological interventions including beta-adrenergic blockers,
typical and atypical antipsychotics, anticonvulsants, dopamine agonists,
psychostimulants, antidepressants, alpha-2-adrenergic agonists, hypnotics, and
anxiolytics.
DISCUSSION: Although agitation is frequent following TBI and pharmacological
agents that are often used, there is no consensus on the most efficacious and
safest strategy to treat these complications. There is a need for an updated
systematic review to summarize the evidence in order to inform practice and
future research. 

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