Patterns of Recovery of Posttraumatic Confusional State in Neurorehabilitation Admissions After Traumatic Brain Injury

Objective: To provide preliminary descriptions of patterns of resolution of symptoms of acute confusion after traumatic brain injury (TBI). Design: Prospective, descriptive, cohort Study. Setting: Inpatient neurorehabilitation unit. Participants: Patients (N=107) meeting criteria for posttraumatic confusional state at admission to inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measure: Patterns of resolution of posttraumatic confusional state symptoms over the first 3 confusion assessment protocol evaluations for patients with mild, moderate, and severe confusion. Results: Posttraumatic confusional state symptoms resolving earliest were psychotic-type symptoms, decreased daytime arousal, and nighttime sleep disturbance. Fluctuation and cognitive impairment were the 2 most persistent symptoms. Seventy-three percent of patients showed improvement of I or more symptoms from the first to third evaluation. Confusion severity groups did not significantly differ on indices of injury severity (Glasgow Coma Scale score, time to follow commands) but did differ on functional status at discharge from inpatient rehabilitation. Conclusions: While posttraumatic confusional state is a heterogeneous disorder, there is a predictable pattern of symptom resolution. Differences in patients' confusion severity and patterns of symptoms may relate to differing underlying neural injury.