Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.
Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.
Ann Phys Rehabil Med. 2021 Sep;64(5):101532. doi: 10.1016/j.rehab.2021.101532. Epub 2021 Jul 16.
Managing agitation is a significant challenge in the early stages of recovery after traumatic brain injury (TBI), and research investigating current practice during this period is lacking.
This study examined how clinicians worldwide conceptualise, measure and manage agitation during early TBI recovery.
A cross-sectional anonymous online survey was distributed via email, newsletters, conferences and social media to clinicians involved in early TBI care worldwide. Respondents were 331 clinicians (66% female) from 34 countries worldwide who worked in inpatient and outpatient settings in disciplines including medicine, nursing and allied health. Participants had an average of 13 years' clinical experience working specifically with an adult TBI population.
Agitated behaviour was commonly defined as aggression and restlessness. Three quarters of clinicians reported that their services measure agitation, and clinicians in North America more frequently use standardised assessment tools. Common non-pharmacological approaches used across all regions surveyed included providing familiarising information (85%) and environmental cues (82%), managing patients in single rooms (81%) and reducing noise levels (80%). Most clinicians (90%) reported pharmacology use, particularly atypical antipsychotic agents. Clinicians' mean rating of confidence in managing agitation was 7 out of 10 (10 being excellent) and was higher for services that provided staff with written guidelines for agitation management. Only half of clinicians reported sufficient training for managing agitation and 52% were satisfied with current agitation management practices.
Despite high rates of agitation measurement and management, many clinicians reported dissatisfaction with current agitation management and insufficient training. This study supports the development of international guidelines and training to ensure consistent and effective agitation management in early TBI care.
在创伤性脑损伤（TBI）后的早期康复阶段，管理激越症状是一项重大挑战，而目前在这一时期进行的研究则对此缺乏调查。
本研究旨在调查全球范围内的临床医生在 TBI 早期康复阶段如何概念化、测量和管理激越症状。
通过电子邮件、时事通讯、会议和社交媒体向全球范围内参与 TBI 早期护理的临床医生分发了一份横断面匿名在线调查。来自 34 个国家的 331 名临床医生（66%为女性）参与了此项研究，他们在包括医学、护理和联合健康等学科的住院和门诊环境中工作。参与者平均有 13 年专门针对成人 TBI 人群的临床经验。
激越行为通常被定义为攻击行为和不安定。四分之三的临床医生报告说，他们的服务会测量激越症状，并且来自北美的临床医生更频繁地使用标准化评估工具。在所有接受调查的地区，常见的非药物干预措施包括提供熟悉的信息（85%）和环境提示（82%）、将患者安置在单人房间中（81%）以及降低噪音水平（80%）。大多数临床医生（90%）报告使用药物治疗，特别是非典型抗精神病药物。临床医生对管理激越症状的信心平均评分为 10 分制的 7 分（10 分为优秀），而提供了管理激越症状书面指南的服务的评分更高。只有一半的临床医生报告说他们有足够的激越管理培训，并且 52%的临床医生对当前的激越管理实践感到满意。
尽管激越症状的测量和管理率很高，但许多临床医生报告对当前的激越管理不满意，并且培训不足。本研究支持制定国际指南和培训计划，以确保在 TBI 早期护理中实现一致和有效的激越管理。
