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Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study

BACKGROUND: Psychiatric sequelae after traumatic brain injury (TBI) are common and may impede recovery. We aimed to assess the occurrence and risk factors of post-injury psychotropic medication use in intensive care unit (ICU)-treated patients with TBI and its association with late mortality. METHOD...

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Autores principales: Vehviläinen, Juho, Skrifvars, Markus B., Reinikainen, Matti, Bendel, Stepani, Marinkovic, Ivan, Ala-Kokko, Tero, Hoppu, Sanna, Laitio, Ruut, Siironen, Jari, Raj, Rahul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437905/
https://www.ncbi.nlm.nih.gov/pubmed/34379205
http://dx.doi.org/10.1007/s00701-021-04956-3
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author Vehviläinen, Juho
Skrifvars, Markus B.
Reinikainen, Matti
Bendel, Stepani
Marinkovic, Ivan
Ala-Kokko, Tero
Hoppu, Sanna
Laitio, Ruut
Siironen, Jari
Raj, Rahul
author_facet Vehviläinen, Juho
Skrifvars, Markus B.
Reinikainen, Matti
Bendel, Stepani
Marinkovic, Ivan
Ala-Kokko, Tero
Hoppu, Sanna
Laitio, Ruut
Siironen, Jari
Raj, Rahul
author_sort Vehviläinen, Juho
collection PubMed
description BACKGROUND: Psychiatric sequelae after traumatic brain injury (TBI) are common and may impede recovery. We aimed to assess the occurrence and risk factors of post-injury psychotropic medication use in intensive care unit (ICU)-treated patients with TBI and its association with late mortality. METHODS: We conducted a retrospective multi-centre observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003–2013 that were alive at 1 year after injury. Patients were followed-up until end of 2016. We obtained data regarding psychotropic medication use through the national drug reimbursement database. We used multivariable logistic regression models to assess the association between TBI severity, treatment-related variables and the odds of psychotropic medication use and its association with late all-cause mortality (more than 1 year after TBI). RESULTS: Of 3061 patients, 2305 (75%) were alive at 1 year. Of these, 400 (17%) became new psychotropic medication users. The most common medication types were antidepressants (61%), antipsychotics (35%) and anxiolytics (26%). A higher Glasgow Coma Scale (GCS) score was associated with lower odds (OR 0.93, 95% CI 0.90–0.96) and a diffuse injury with midline shift was associated with higher odds (OR 3.4, 95% CI 1.3–9.0) of new psychotropic medication use. After adjusting for injury severity, new psychotropic medication use was associated with increased odds of late mortality (OR 1.19, 95% CI 1.19–2.17, median follow-up time 6.4 years). CONCLUSIONS: Psychotropic medication use is common in TBI survivors. Higher TBI severity is associated with increased odds of psychotropic medication use. New use of psychotropic medications after TBI was associated with increased odds of late mortality. Our results highlight the need for early identification of potential psychiatric sequelae and psychiatric evaluation in TBI survivors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-021-04956-3.
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spelling pubmed-84379052021-09-29 Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study Vehviläinen, Juho Skrifvars, Markus B. Reinikainen, Matti Bendel, Stepani Marinkovic, Ivan Ala-Kokko, Tero Hoppu, Sanna Laitio, Ruut Siironen, Jari Raj, Rahul Acta Neurochir (Wien) Original Article - Brain trauma BACKGROUND: Psychiatric sequelae after traumatic brain injury (TBI) are common and may impede recovery. We aimed to assess the occurrence and risk factors of post-injury psychotropic medication use in intensive care unit (ICU)-treated patients with TBI and its association with late mortality. METHODS: We conducted a retrospective multi-centre observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003–2013 that were alive at 1 year after injury. Patients were followed-up until end of 2016. We obtained data regarding psychotropic medication use through the national drug reimbursement database. We used multivariable logistic regression models to assess the association between TBI severity, treatment-related variables and the odds of psychotropic medication use and its association with late all-cause mortality (more than 1 year after TBI). RESULTS: Of 3061 patients, 2305 (75%) were alive at 1 year. Of these, 400 (17%) became new psychotropic medication users. The most common medication types were antidepressants (61%), antipsychotics (35%) and anxiolytics (26%). A higher Glasgow Coma Scale (GCS) score was associated with lower odds (OR 0.93, 95% CI 0.90–0.96) and a diffuse injury with midline shift was associated with higher odds (OR 3.4, 95% CI 1.3–9.0) of new psychotropic medication use. After adjusting for injury severity, new psychotropic medication use was associated with increased odds of late mortality (OR 1.19, 95% CI 1.19–2.17, median follow-up time 6.4 years). CONCLUSIONS: Psychotropic medication use is common in TBI survivors. Higher TBI severity is associated with increased odds of psychotropic medication use. New use of psychotropic medications after TBI was associated with increased odds of late mortality. Our results highlight the need for early identification of potential psychiatric sequelae and psychiatric evaluation in TBI survivors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-021-04956-3. Springer Vienna 2021-08-11 2021 /pmc/articles/PMC8437905/ /pubmed/34379205 http://dx.doi.org/10.1007/s00701-021-04956-3 Text en © The Author(s) 2021, corrected publication 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article - Brain trauma
Vehviläinen, Juho
Skrifvars, Markus B.
Reinikainen, Matti
Bendel, Stepani
Marinkovic, Ivan
Ala-Kokko, Tero
Hoppu, Sanna
Laitio, Ruut
Siironen, Jari
Raj, Rahul
Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study
title Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study
title_full Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study
title_fullStr Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study
title_full_unstemmed Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study
title_short Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study
title_sort psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study
topic Original Article - Brain trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437905/
https://www.ncbi.nlm.nih.gov/pubmed/34379205
http://dx.doi.org/10.1007/s00701-021-04956-3
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