Abstract Details

Title Antipsychotic Practice Patterns and Clinical Outcomes in Moderate-to-severe TBI

Topic Neuro Trauma and Critical Care

Presentation(s) P10 - Poster Session 10 (5:00 PM-6:00 PM)

Poster/Presentation
Number 7-005

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.

Authors/Disclosures
Sebastian Hanna, MD PRESENTER	Mr. Hanna has nothing to disclose.
Ashish Ramesh	Mr. Ramesh has nothing to disclose.
Claire Joyner	Miss Joyner has received research support from National Institute of Health. Miss Joyner has received research support from UCI MIND.
Sonja Darwish, MD	Dr. Darwish has nothing to disclose.
Yama Akbari, MD, PhD (University of California, Irvine)	Dr. Akbari has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for AZ Injury Law. The institution of Dr. Akbari has received research support from NIH. The institution of Dr. Akbari has received research support from Hamamatsu Photonics KK. Dr. Akbari has received intellectual property interests from a discovery or technology relating to health care.
Sara J. Stern-Nezer, MD (University of California, Irvine)	Dr. Stern-Nezer has nothing to disclose.
Cyrus K. Dastur, MD (UC Irvine Medical Center)	Dr. Dastur has nothing to disclose.
Walter W. Valesky, Jr., MD (Suny Downstate Medical Center)	Dr. Valesky has nothing to disclose.
Michelle F. Goodwin, MD	Dr. Goodwin has nothing to disclose.
Wengui Yu, MD, PhD (UC Irvine, Neurology Dept)	Dr. Yu has nothing to disclose.
Jeff W. Chen, MD, PhD	The institution of Dr. Chen has received research support from Mitsubishi.
Areg Grigorian	Areg Grigorian has nothing to disclose.
Jeffry Nahmias, MD, MHPE	Dr. Nahmias has nothing to disclose.
Patrick M. Chen, MD (UC Irvine Medical Center)	Dr. Chen has nothing to disclose.

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