• Mark Sherer, Risa Nakase-Thompson, Stuart A Yablon, and Samuel T Gontkovsky.
• Methodist Rehabilitation Center, Jackson, MS, USA. marks@mmrcrehab.org
• Arch Phys Med Rehabil. 2005 May 1; 86 (5): 896-904.

ObjectivesTo describe the phenomenology of posttraumatic confusional state (PTCS) and to provide preliminary validation of a new procedure, the Confusion Assessment Protocol (CAP), for assessing PTCS.DesignCriterion standard investigation.SettingInpatient traumatic brain injury (TBI) rehabilitation program.ParticipantsTwo consecutive series of patients (n=62, n=93) with TBI admitted for inpatient rehabilitation.InterventionsNot applicable.Main Outcome MeasuresClinical diagnosis of delirium based on Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria, classification of posttraumatic amnesia (PTA) based on the Galveston Orientation and Amnesia Test (GOAT), and Disability Rating Scale score at time of rehabilitation hospital discharge. Results Agreement between the diagnosis of PTCS with the CAP and DSM-IV classification of delirium was 87%, and agreement between PTCS and PTA using GOAT criteria was 90%. Patients classified as in PTCS sustained more severe injuries and required longer rehabilitation stays. Confusion status was associated with poorer functional status at rehabilitation discharge.ConclusionsThe CAP is a brief, structured, repeatable measure of multiple neurobehavioral aspects of PTCS. Confusion status as determined by CAP assessment contributed to prediction of outcome at rehabilitation discharge after adjustment for other potential predictors.

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