University of Oulu

Vehviläinen, J., Skrifvars, M.B., Reinikainen, M. et al. Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study. Acta Neurochir 163, 2909–2917 (2021).

Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit : a multi-centre observational study

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Author: Vehviläinen, Juho1; Skrifvars, Markus B.2; Reinikainen, Matti3;
Organizations: 1Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, P.B. 266, 00029 HUS, Helsinki, Finland
2Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3Department of Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
4Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
5Department of Intensive Care, Oulu University Hospital & University of Oulu, Oulu, Finland
6Department of Intensive Care and Emergency Medicine Services, Tampere University Hospital & University of Tampere, Tampere, Finland
7Department of Intensive Care, Turku University Hospital & University of Turku, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
Persistent link:
Language: English
Published: Springer Nature, 2021
Publish Date: 2021-11-12


Background: Psychiatric sequelae after traumatic brain injury (TBI) are common and may impede recovery. We aimed to assess the occurrence and risk factors of post-injury psychotropic medication use in intensive care unit (ICU)-treated patients with TBI and its association with late mortality.

Methods: We conducted a retrospective multi-centre observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003–2013 that were alive at 1 year after injury. Patients were followed-up until end of 2016. We obtained data regarding psychotropic medication use through the national drug reimbursement database. We used multivariable logistic regression models to assess the association between TBI severity, treatment-related variables and the odds of psychotropic medication use and its association with late all-cause mortality (more than 1 year after TBI).

Results: Of 3061 patients, 2305 (75%) were alive at 1 year. Of these, 400 (17%) became new psychotropic medication users. The most common medication types were antidepressants (61%), antipsychotics (35%) and anxiolytics (26%). A higher Glasgow Coma Scale (GCS) score was associated with lower odds (OR 0.93, 95% CI 0.90–0.96) and a diffuse injury with midline shift was associated with higher odds (OR 3.4, 95% CI 1.3–9.0) of new psychotropic medication use. After adjusting for injury severity, new psychotropic medication use was associated with increased odds of late mortality (OR 1.19, 95% CI 1.19–2.17, median follow-up time 6.4 years).

Conclusions: Psychotropic medication use is common in TBI survivors. Higher TBI severity is associated with increased odds of psychotropic medication use. New use of psychotropic medications after TBI was associated with increased odds of late mortality. Our results highlight the need for early identification of potential psychiatric sequelae and psychiatric evaluation in TBI survivors.

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Series: Acta neurochirurgica
ISSN: 0001-6268
ISSN-E: 0942-0940
ISSN-L: 0001-6268
Volume: 163
Issue: 10
Pages: 2909 - 2917
DOI: 10.1007/s00701-021-04956-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Open access funding provided University of Helsinki including Helsinki University Central Hospital. Independent funding support has been received from Helsinki University Hospital (State funding, Finland VTR TYH2018227); Finska Läkaresällskapet; Medicinska Understödsföreningen Liv & Hälsa; Svenska Kulturfonden and Maire Taponen foundation. The funders had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript. The first and last author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Copyright information: © The Author(s) 2021, corrected publication 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit