Definition of agitation following traumatic brain injury: I. A survey of the brain injury special interest group of the American Academy of Physical Medicine and Rehabilitation

Lisa P. Fugate, Lisa A. Spacek, Laura A. Kresty, Charles E. Levy, Jane C. Johnson, W. Jerry Mysiw

Research output: Contribution to journalArticle

Abstract

Objective: To determine national patterns of defining agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors. Design: A random sample of 70% of the members of the Brain Injury Special Interest Group (SIG) of the American Academy of Physical Medicine and Rehabilitation (AAPM and R) were surveyed by telephone. Results: The 129 members who responded yielded an 82% response rate. Respondents rated 18 characteristics from established rating scales on a 5-point scale according to each characteristic's relation to its clinical definition of agitation. Physical aggression, explosive anger, increased psychomotor activity, impulsivity, verbal aggression, disorganized thinking, perceptual disturbances, and reduced ability to maintain or appropriately shift attention were rated by at least 50% of the sample as very important or essential to agitation. Delirium, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has been proposed as a standard definition of agitation. The degree to which all characteristics from the 3rd revised edition of the DSM (DSM-IIIR), considered together, were perceived to relate to agitation predicted 24% of the degree to which the term 'delirium' was perceived to relate to agitation (Canonical correlation r = .48, p = .0002). Physicians' ratings of individual delirium characteristics from the DSM-IIIR were examined to determine if a sufficient number were similarly ranked to fulfill the diagnostic criteria for delirium. A significant number of physicians rated diagnostic criteria for delirium in one direction, yet did not rank the term 'delirium' accordingly (McNemar's p = .04). Conclusions: There is considerable variation among physiatrists in their rating of characteristics that define agitation. Many define agitation during the acute recovery phase as posttraumatic amnesia plus an excess of behavior such as aggression, disinhibition, and/or emotional lability. Less support was given to defining agitation by the DSM-IIIR or DSM-IV diagnostic criteria for delirium. Delirium appears related to, but is not sufficient for, a diagnosis of agitation.

Original languageEnglish (US)
Pages (from-to)917-923
Number of pages7
JournalArchives of Physical Medicine and Rehabilitation
Volume78
Issue number9
DOIs
StatePublished - Sep 1997
Externally publishedYes

Fingerprint

Physical and Rehabilitation Medicine
Public Opinion
Delirium
Brain Injuries
Aggression
Diagnostic and Statistical Manual of Mental Disorders
Physicians
Aptitude
Amnesia
Surveys and Questionnaires
Traumatic Brain Injury
Impulsive Behavior
Anger
Telephone
Survivors

ASJC Scopus subject areas

  • Rehabilitation

Cite this

Definition of agitation following traumatic brain injury : I. A survey of the brain injury special interest group of the American Academy of Physical Medicine and Rehabilitation. / Fugate, Lisa P.; Spacek, Lisa A.; Kresty, Laura A.; Levy, Charles E.; Johnson, Jane C.; Mysiw, W. Jerry.

In: Archives of Physical Medicine and Rehabilitation, Vol. 78, No. 9, 09.1997, p. 917-923.

Research output: Contribution to journalArticle

Fugate, Lisa P. ; Spacek, Lisa A. ; Kresty, Laura A. ; Levy, Charles E. ; Johnson, Jane C. ; Mysiw, W. Jerry. / Definition of agitation following traumatic brain injury : I. A survey of the brain injury special interest group of the American Academy of Physical Medicine and Rehabilitation. In: Archives of Physical Medicine and Rehabilitation. 1997 ; Vol. 78, No. 9. pp. 917-923.
@article{63345671aa2b48d187dec0428200e08d,
title = "Definition of agitation following traumatic brain injury: I. A survey of the brain injury special interest group of the American Academy of Physical Medicine and Rehabilitation",
abstract = "Objective: To determine national patterns of defining agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors. Design: A random sample of 70{\%} of the members of the Brain Injury Special Interest Group (SIG) of the American Academy of Physical Medicine and Rehabilitation (AAPM and R) were surveyed by telephone. Results: The 129 members who responded yielded an 82{\%} response rate. Respondents rated 18 characteristics from established rating scales on a 5-point scale according to each characteristic's relation to its clinical definition of agitation. Physical aggression, explosive anger, increased psychomotor activity, impulsivity, verbal aggression, disorganized thinking, perceptual disturbances, and reduced ability to maintain or appropriately shift attention were rated by at least 50{\%} of the sample as very important or essential to agitation. Delirium, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has been proposed as a standard definition of agitation. The degree to which all characteristics from the 3rd revised edition of the DSM (DSM-IIIR), considered together, were perceived to relate to agitation predicted 24{\%} of the degree to which the term 'delirium' was perceived to relate to agitation (Canonical correlation r = .48, p = .0002). Physicians' ratings of individual delirium characteristics from the DSM-IIIR were examined to determine if a sufficient number were similarly ranked to fulfill the diagnostic criteria for delirium. A significant number of physicians rated diagnostic criteria for delirium in one direction, yet did not rank the term 'delirium' accordingly (McNemar's p = .04). Conclusions: There is considerable variation among physiatrists in their rating of characteristics that define agitation. Many define agitation during the acute recovery phase as posttraumatic amnesia plus an excess of behavior such as aggression, disinhibition, and/or emotional lability. Less support was given to defining agitation by the DSM-IIIR or DSM-IV diagnostic criteria for delirium. Delirium appears related to, but is not sufficient for, a diagnosis of agitation.",
author = "Fugate, {Lisa P.} and Spacek, {Lisa A.} and Kresty, {Laura A.} and Levy, {Charles E.} and Johnson, {Jane C.} and Mysiw, {W. Jerry}",
year = "1997",
month = "9",
doi = "10.1016/S0003-9993(97)90050-2",
language = "English (US)",
volume = "78",
pages = "917--923",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
number = "9",

}

TY - JOUR

T1 - Definition of agitation following traumatic brain injury

T2 - I. A survey of the brain injury special interest group of the American Academy of Physical Medicine and Rehabilitation

AU - Fugate, Lisa P.

AU - Spacek, Lisa A.

AU - Kresty, Laura A.

AU - Levy, Charles E.

AU - Johnson, Jane C.

AU - Mysiw, W. Jerry

PY - 1997/9

Y1 - 1997/9

N2 - Objective: To determine national patterns of defining agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors. Design: A random sample of 70% of the members of the Brain Injury Special Interest Group (SIG) of the American Academy of Physical Medicine and Rehabilitation (AAPM and R) were surveyed by telephone. Results: The 129 members who responded yielded an 82% response rate. Respondents rated 18 characteristics from established rating scales on a 5-point scale according to each characteristic's relation to its clinical definition of agitation. Physical aggression, explosive anger, increased psychomotor activity, impulsivity, verbal aggression, disorganized thinking, perceptual disturbances, and reduced ability to maintain or appropriately shift attention were rated by at least 50% of the sample as very important or essential to agitation. Delirium, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has been proposed as a standard definition of agitation. The degree to which all characteristics from the 3rd revised edition of the DSM (DSM-IIIR), considered together, were perceived to relate to agitation predicted 24% of the degree to which the term 'delirium' was perceived to relate to agitation (Canonical correlation r = .48, p = .0002). Physicians' ratings of individual delirium characteristics from the DSM-IIIR were examined to determine if a sufficient number were similarly ranked to fulfill the diagnostic criteria for delirium. A significant number of physicians rated diagnostic criteria for delirium in one direction, yet did not rank the term 'delirium' accordingly (McNemar's p = .04). Conclusions: There is considerable variation among physiatrists in their rating of characteristics that define agitation. Many define agitation during the acute recovery phase as posttraumatic amnesia plus an excess of behavior such as aggression, disinhibition, and/or emotional lability. Less support was given to defining agitation by the DSM-IIIR or DSM-IV diagnostic criteria for delirium. Delirium appears related to, but is not sufficient for, a diagnosis of agitation.

AB - Objective: To determine national patterns of defining agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors. Design: A random sample of 70% of the members of the Brain Injury Special Interest Group (SIG) of the American Academy of Physical Medicine and Rehabilitation (AAPM and R) were surveyed by telephone. Results: The 129 members who responded yielded an 82% response rate. Respondents rated 18 characteristics from established rating scales on a 5-point scale according to each characteristic's relation to its clinical definition of agitation. Physical aggression, explosive anger, increased psychomotor activity, impulsivity, verbal aggression, disorganized thinking, perceptual disturbances, and reduced ability to maintain or appropriately shift attention were rated by at least 50% of the sample as very important or essential to agitation. Delirium, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has been proposed as a standard definition of agitation. The degree to which all characteristics from the 3rd revised edition of the DSM (DSM-IIIR), considered together, were perceived to relate to agitation predicted 24% of the degree to which the term 'delirium' was perceived to relate to agitation (Canonical correlation r = .48, p = .0002). Physicians' ratings of individual delirium characteristics from the DSM-IIIR were examined to determine if a sufficient number were similarly ranked to fulfill the diagnostic criteria for delirium. A significant number of physicians rated diagnostic criteria for delirium in one direction, yet did not rank the term 'delirium' accordingly (McNemar's p = .04). Conclusions: There is considerable variation among physiatrists in their rating of characteristics that define agitation. Many define agitation during the acute recovery phase as posttraumatic amnesia plus an excess of behavior such as aggression, disinhibition, and/or emotional lability. Less support was given to defining agitation by the DSM-IIIR or DSM-IV diagnostic criteria for delirium. Delirium appears related to, but is not sufficient for, a diagnosis of agitation.

UR - http://www.scopus.com/inward/record.url?scp=0030931836&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030931836&partnerID=8YFLogxK

U2 - 10.1016/S0003-9993(97)90050-2

DO - 10.1016/S0003-9993(97)90050-2

M3 - Article

C2 - 9305261

AN - SCOPUS:0030931836

VL - 78

SP - 917

EP - 923

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

IS - 9

ER -