Antipsychotic Practice Patterns and Clinical Outcomes in Moderate-to-severe TBI
Sebastian Hanna1, Ashish Ramesh1, Claire Joyner1, Sonja Darwish1, Yama Akbari1, Sara Stern-Nezer1, Cyrus Dastur1, Walter Valesky1, Michelle Goodwin1, Wengui Yu1, Jefferson Chen2, Areg Grigorian3, Jeffry Nahmias3, Patrick Chen1
1Neurology TBI & Concussion (NTBIC) Program Department of Neurology, University of California, Irvine, 2Department of Neurosurgery, University of California, Irvine, 3Department of Surgery, University of California, Irvine
Objective:
In this study, we sought to assess the pattern of antipsychotics used for moderate-severe TBI (msTBI) and their relationship to functional outcomes.
Background:
msTBI may result in episodes of agitation and delirium throughout hospital stay. In managing these episodes, atypical antipsychotics are largely preferred to typical agents in a msTBI population due to their reduced side-effect burden and less deleterious effect on recovery.
Design/Methods:
A single-center retrospective cohort study of msTBI patients (initial GCS <14 with ICU admission) was performed (10/2022-10/2024). Patients receiving antipsychotics during hospitalization (quetiapine/olanzapine/risperidone) were compared to those who did not. Outcomes included poor outcome defined as mRS 5-6, and length-of-stay. Univariate and multivariate analyses were performed to assess relationship between variables and outcomes (significance p<0.05).
Results:
Of 129 included patients (median 47 years [IQR 29-67], initial GCS 8 [IQR 4-12], 42 (32.6%) were treated with antipsychotics (81.4% seroquel, mean dose 131mg daily). When compared to the no-antipsychotic cohort, those receiving antipsychotics were younger (37 [28.25-58] vs 57 [32-73], p=0.021). The antipsychotic cohort had decreased mortality (0% (0/42) vs. 33.3% (29/87), p<0.001) and increased median length of stay (24.5 vs. 13 days, p<0.001). In multiple logistic regression, age [OR 1.02, CI 1.00-1.05, p=0.023], initial GCS [OR 0.89, CI 0.80-0.98, p=0.022], blown pupils at admission [OR 3.33, CI 1.35-8.24, p=0.009], and antipsychotic use [OR 0.27, CI 0.10-0.71, p=0.008] showed significant associations with poor outcome.
Conclusions:
The administration of antipsychotics in msTBI patients appears to be influenced by local prescribing habits, correlating with younger age and longer hospital stays. Agitation and antipsychotic use may reflect lower severity TBI in patients that ultimately survive. Future prospective studies are needed to further elucidate the clinical endophenotypes between antipsychotic responders.
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