LAUSR

Learning Objectives: Traumatic brain injury (TBI) is the most common cause of death and disability in persons between 15 and 30 years of age. Few trials have studied modafinil, methylphenidate, amantadine, and zolpidem as awakening agents in acute TBI patients. The objective of this study was to determine the effect of modafinil, methylphenidate, amantadine, and zolpidem in improving wakefulness in intensive care unit (ICU) TBI patients, and to identify any possible adverse drug reactions. Methods: This was a single-center, retrospective cohort study of patients admitted to NYU Winthrop Hospital, Mineola from 2013 to 2017. The electronic medical record system identified patients who had been prescribed any dose of modafinil, methylphenidate, amantadine, or zolpidem. Only patients older than 18 years with TBI in an ICU setting were further analyzed. The following data were collected: patient age, gender, ethnicity, nature of TBI, drug dosage, treatment duration, Glasgow Coma Scale (GCS) score, length of time to improve GCS score, hospital length of stay, reported adverse drug reactions associated with above medications, and mortality. Based on the GCS scores, the investigators determined if these medications had an impact on improving the patients’ neurological status; a positive response to a medication was defined as an increase in the GCS score by at least one point. Descriptive statistics were used to analyze the data. Results: A total of 53 patients were included. Amantadine had a positive response rate of 90%, followed by modafinil at 77%, methylphenidate 50%, and then zolpidem 36%. The change in baseline GCS score and median final GCS score for amantadine, modafinil, methylphenidate, and zolpidem was 2.5, 3.0, 1, and 0, respectively (p = 0.02). The median time to response in days was 1.5, 1, 0.5, and 1, respectively. The agents were associated with few adverse events. The most common adverse events were agitation, hypertension, and posturing. Deaths were not attributable to the medications. Conclusions: Amantadine, followed by modafinil, had the highest positive response rate. Medications were also associated with few adverse events. Although certain medications may have had a higher response rate, larger studies are required to confirm the present findings.