Study Identifies Promising Approaches to Managing Agitation in TBI Patients

A recent study published in Volume 12 of the Chinese Neurosurgical Journal on August 11, 2026, has shed light on the management of agitation in patients with traumatic brain injury (TBI). The research, conducted by a team from Astley Ainslie Hospital in the UK, reviewed 13 studies published over the past decade to identify promising approaches to managing agitation, a common complication in TBI patients.

Agitation, characterized by restlessness, impulsive behavior, irritability, and aggression, affects a significant portion of TBI patients. According to the study, up to 41% of patients experience agitation in acute care settings, while this figure rises to as high as 70% in rehabilitation units. This condition not only poses a risk to patient safety but also complicates the recovery process and increases the burden on healthcare staff.

Traumatic brain injury is a major cause of death and disability worldwide, with over 214,000 TBI-related hospitalizations reported in the United States in 2020 alone. For individuals with moderate to severe TBI, the recovery journey can be particularly challenging due to the high prevalence of agitation. Despite the significant impact of this condition, there is currently no standardized approach to managing agitation in TBI patients.

The research team, led by Dr. Irrum Aneela, conducted a scoping review of the existing literature, searching the PubMed, Embase, and Cochrane databases. They identified 65 records published between January 2015 and March 2026, from which they selected 13 studies for a more detailed analysis. The findings highlighted the need for more precise measures and larger clinical trials to guide safer, evidence-based care.

Non-pharmacological approaches, such as reducing noise, placing patients in single rooms, and involving family members in care, were among the most frequently used strategies. Clinicians also reported the value of helping patients understand their surroundings, maintaining consistent behavioral support, and minimizing environmental triggers. Families played a crucial role in supporting patient recovery, with Dr. Aneela noting that being informed about the patient's short-term and long-term recovery was essential. Keeping families informed about the current care plan and their needs could empower them to support their loved one's recovery and remain engaged in the process.

While several medications showed potential for reducing agitation, the evidence remains limited. A randomized controlled trial suggested potential benefits of the antipsychotic drug olanzapine during post-traumatic amnesia, but this study included only 11 participants. Valproic acid was associated with improvements in a small case series involving three male patients, and another report described the benefits of dextromethorphan combined with quinidine. However, further research is needed to thoroughly understand the effectiveness and safety of these medications.

Dr. Aneela emphasized that treatment decisions should be tailored to each individual rather than applied uniformly. This approach may help clinicians consider underlying health conditions, previous psychiatric diagnoses, and other factors that could influence agitation or treatment responses.

The study's findings underscore the need for more robust clinical evidence. Most of the included literature comprised observational studies, surveys, and previous reviews, leaving a gap in strong clinical evidence. Establishing consistent measures of agitation and using them in large clinical trials should be a priority in the field. Such efforts could help turn current practice into evidence-based care that supports patients, families, and healthcare staff alike.

Astley Ainslie Hospital, a prominent NHS Scotland healthcare facility located in the Grange area of Edinburgh, specializes in rehabilitation and outpatient services. The hospital provides dedicated care for patients recovering from stroke, brain injuries, orthopedic conditions, and age-related conditions.