Behavioral disorders (BD) after Traumatic Brain Injury (TBI) are common and have a major impact on the patient, his family and caregivers, leading to longer length of stay in hospitalization, and difficulties of social rehabilitation. The usual psychoactive drugs are not efficient, leading to side effects harmful for neurological recovery. French guidelines about management of these BD have been elaborated by the French Society of Physical and Rehabilitation Medicine and the French High Authority for Health in July 2013. We focused on pharmacological interventions of disruptive behavior by excess (aggressiveness, agitation, irritability). Propranolol is recommended in first-line treatment, mood regulating antiepileptics in second.

The purpose of this work was to evaluate the impact of the guidelines on the practitioner's prescriptions for BD in intensive care, neurosurgery and physical and rehabilitation medicine (PRM) units. We compared the period 2011–2012 versus 2014–2015.

This was a retrospective, descriptive, multicentric study. All adult patients with TBI hospitalized at primary stage in PRM, in the PRM center of Nantes and Angers University Hospitals were included.

Among 208 patients analyzed, 84 (40,4%) had BD by excess. Propranolol was more prescribed after the guidelines: 34% vs 13.5% (P=0.03). It was prescribed at the average dose of 45mg, guidelines recommend 40 to 80mg. Over 21 prescriptions of Propranolol, 10 were stopped, 3 for cardiovascular side effects. Patients with BD had more psychoactive drugs prescribed (2.7 vs. 0.93, P<0.05) and there was no difference between before and after the guidelines (2.95 vs. 2.51, P=0.33). PRM specialists prescribed more psychoactive drugs than the others. Intensive care specialists never prescribed mood regulating antiepileptics.

There is a need to inform all the doctors who take care of these patients about the guidelines. Propranolol is more prescribed but at the limit of the efficient dose, and psychoactive drugs are still long-term prescribed.