Assessment and management of patients in the acute stages of recovery following traumatic brain injury in adults- a world-wide survey.

Most individuals with traumatic brain injury (TBI) experience a period of confusion following emergence from coma, termed post-traumatic amnesia, post-traumatic confusional state or delirium. Recent guidelines suggest the importance of assessment and consistent management during this phase, but current practice worldwide remains unknown. This survey aimed to elucidate current international practice in assessment and management of patients in the acute stages of recovery after TBI. The web-based survey was distributed to clinicians working with acute TBI patients. There were 400 participants (68.8% females), from 41 countries, mostly neuropsychologists, rehabilitation physicians and occupational therapists (OTs), with an average 12.8 years' experience. Of those working with adults (n=376, 94%), most described this acute period as post-traumatic amnesia and used its duration to indicate injury severity. More than 85% used a tool to assess patients; in order of frequency, the Glasgow Coma Scale (GCS), Westmead PTA Scale (WPTAS), Galveston Orientation and Amnesia Test, Rancho Los Amigos Scale and O-Log. Meeting criteria on the assessment tool or clinical judgement determined emergence from this phase, indicated by recovery of orientation, day to day memories, ability to follow commands or participate in rehabilitation. Most patients had physiotherapy, OT, speech therapy, and environmental changes, with a third of participants indicating sedating medication was prescribed during this phase. Findings suggest that, consistent with guidelines, PTA is a widely recognised and measured TBI recovery phase, used to determine injury severity and readiness for therapy.