Document Type : Original Article

Authors

1 Associate Professor of Neurosurgery, Spine Fellowship, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

2 Assistant Professor of Neurosurgery, Functional Fellowship, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

3 Associate Professor of Psychiatry, Department of Psychiatry, School of Medicine, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.

4 Assistant Professor of Critical Care Medicine, Department of Anesthesiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

5 MD, Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

6 MD, Ph.D. of Epidemiology, Department of Community Health, Mazandaran University of Medical Sciences, Sari, Iran.

10.30491/tm.2022.328724.1445

Abstract

Background: This study aimed to evaluate the effect of methylphenidate on the level of consciousness and length of hospitalization of patients with moderate to severe acute traumatic brain injury (TBI) categorized as diffuse axonal injury.
Methods: This study is a randomized, double-blind clinical trial. The study population comprised 62 patients with moderate to severe traumatic brain injury with GCS (Glasgow coma scale) between 5 and 12 referred to the emergency department. Methylphenidate was administered as a tablet from the second day at a dose of 0.3 mg/kg/ up to a maximum of 20 mg daily. And a placebo was administered in the same form and order for the patients. The patient's level of consciousness, delirium using the CAM-ICU (Confusion Assessment Method for the intensive care unit) and agitation using RASS (Richmond Agitation Sedation Scale), and predicting outcome the outcome of patients with GOS (Glasgow Outcome Scale), were assessed.
Results: Patients' GOS on the day of discharge was significantly higher in the intervention group (P=0.013). The duration of hospitalization was significantly shorter in the intervention group (P<0.001). The period of ICU hospitalization was also considerably more straightforward in the intervention group (P=0.014). The patients' GCS on discharge day was significantly higher in the intervention group (P=0.01). There were no significant differences in delirium score and agitation between the two groups.
Conclusion: Our results suggest that methylphenidate has some beneficial effects on the consciousness level and outcomes of patients with acute TBI compared to a placebo. The use of methylphenidate also reduces the length of hospital stay and ICU stay and improves the outcome in patients with moderate to severe TBI who do not require surgery.

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