Evaluation of Agitation and Delirium

The assessment of anxiety, agitation, delirium as well as pain can be complicated by the presence of traumatic brain injury (TBI). TBI, in addition to overall injury burden, and therapeutic interventions can affect the evaluation for agitation as well as impede an accurate neurologic assessment. Moderate to severe TBI patients are at particularly high risk for having atypical and/or paradoxical reactions to both sedating and stimulating agents.17,18 In addition, the reactions to individual agents and their overall impact on the TBI patient in terms of pain, alertness, agitation, anxiety, and delirium may change drastically over relatively short periods of time as their injury and cognitive status evolves. The following tools help with pain evaluation: Richmond Agitation Sedation Scale (RASS), and the Confusion Assessment Method (CAM); they are included as Appendix D and Appendix E.