Abstract | November 8, 2021

Anti-psychotic Use in TBI Management: A Descriptive Analysis

Presenting Author: Brennan Robert Gagen, BS, Medical Student, 4th Year, Department of Surgery, Tulane University, New Orleans, LA, New Orleans, LA

Coauthors: Brennan Gagen, BS, Medical Student, Tulane University School of Medicine, New Orleans, LA; Jessica Friedman, MD, General Surgery, PGY7, Tulane University School of Medicine, New Orleans, LA; Kristen Nordham, BS, Medical Student, Tulane University School of Medicine, New Orleans, LA; Scott Ninokawa, BS, Medical Student, Tulane University School of Medicine, New Orleans, LA; Yusuke Nakagawa, BS, Medical Student, Tulane University School of Medicine, New Orleans, LA; Juan Duchesne, MD, Professor and Chief of Trauma, Acute Care, and Critical Care, General Surgery, Tulane University, New Orleans, LA; Chrissy Guidry, DO, Associate Program Director, General Surgery, Tulane University, New Orleans, LA.

Learning Objectives

  1. Examine and consider the use of antipsychotics in treatment of patients with traumatic brain injury in the ICU. 
  2. Describe the role that antipsychotics play in preventing secondary brain injury following a primary traumatic brain injury. 

Background: While Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality, optimizing medical management remains in question. Recent data supports the use of anti-psychotics in the ICU for patients with TBI. Currently, there is a lack of a consistent standard in regard to the use of anti-psychotics in the management of patients with TBI. This study is a descriptive analysis of the use of anti-psychotics in the management of patients with TBI in a TICU of a Level 1 trauma center in an urban setting. 

Methods: This study consisted of a retrospective chart review of 1,256 patients with penetrating or blunt TBI from January 1, 2016 – June 30, 2018, admitted to a TICU at an urban Level 1 trauma center. Data was gathered on the dose of antipsychotic along with the total amount that each patient received. ISS and ICU LOS were also evaluated. Analysis of ISS, drug dosing, and ICU LOS was performed with ANOVA. 

Results: A total of 1,256 patients were admitted to the TICU for TBI, with 161 (12.8%) of patients receiving anti-psychotic medication. Seventy-four patients received Haloperidol, 90 patients received Quetiapine, and 34 patients received Olanzapine. Mean ISS for anti-psychotic treatment was 18.6 +/- 9.6 and without was 15.9 +/- 10.3 (p=0.002). Mean mortality for patients with anti-psychotic treatment was 6.2% and without anti-psychotic was 14.8% (p=0.003). 

Conclusion: Secondary insult prevention with medical interventions for patients with TBIs has not been fully described. Although this study shows a small minority of patients treated with anti-psychotics, it demonstrates a decreased mortality with use in management. Future studies are needed to clarify guidelines and the role of anti-psychotic medication in secondary insult prevention to optimize patient outcomes after admission to the TICU. 

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