Introduction: Amantadine Hydrochloride (AH) administration for traumatic brain injury (TBI) has been demonstrated to improve cognitive and function in the post-acute rehabilitation phase (1). This retrospective study investigates outcome variables in the pre-rehabilitation acute hospitalization phase of severe TBI treated with AH.

Methods: Demographic, injury, outcome, and disposition data were collected and analyzed for patients admitted to a level 1 trauma institution for severe TBI (GCS=8). Exclusion criteria was penetrating injury. Inclusion criteria was AH administration in the ICU. Patients were matched by Injury Severity Score (ISS), GCS score, and age resulting in 22 with AH treatment (AH Group) and 22 with no AH treatment (Controls).

Results: AH Group and Controls had similar ages (37.0 and 36.1, respectively, p=0.793) and gender compositions (73% and 86% males, respectively, p=0.262). On-Scene Initial GCS was 4.7 in AH Group and 4.3 in Controls, p=0.321. ISS was 28.6 in AH Group and 28.8 in Controls, p=0.949. Total Days Admitted were similar in AH group (26.1) and in Controls (20.2), p=0.104). Total ICU Days were not different (13.9 vs 11.0, p=0.168). Discharge Disability Rating Scores were 14.3 and 11.5, p=0.153, in AH and control groups. Disposition was not different in AH Group and Controls for outpatient rehabilitation (41% vs 50%), acute rehab (32% vs 32%), or subacute rehab (14% vs 14%), p=0.951

Conclusions: Matched for injury severity, GCS, and age, AH use did not demonstrate clear improvement after acute hospitalization administration compared with controls. In recent randomized control studies amantadine showed considerable benefit for TBI in the post acute rehabilitation setting. This outcome was not demonstrated in our investigation. Further prospective studies are needed to fully evaluate AH use in acute hospitalization.

Patient Care: This study has potential to improve future patient care by providing preliminary data that encourages a future prospective study to evaluate amantadine use in the treatment of acute TBI.

Learning Objectives: By the conclusion of this session, participants should be able to discuss outcomes of acute hospitalization after Amantadine Hydrochloride administration in the ICU of patients with severe TBI.

References: Joseph T. Giacino, Ph.D., John Whyte, M.D., Ph.D., Emilia Bagiella, et al. Placebo-Controlled Trial of Amantadine for Severe Traumatic Brain Injury. n engl j med 366(9):819-826, 2012