Untangling the Confusion: A Scoping Review of Terminology and Assessment Methods for Acute Confusional States Following Traumatic Brain Injury.

INTRODUCTION

Hospitalized adults with traumatic brain injury (TBI) often experience acute confusional states. However, conceptual clarity remains limited because of overlapping terminology, which hinders assessment.

OBJECTIVES

This study aimed to map the terminology and assessment of acute confusional states in hospitalized TBI adults and examine their alignment with established definitions.

METHODS

We conducted a scoping review (2013-2025) in 4 databases (MEDLINE, PsycInfo, CINAHL, and Google Scholar) following the Arksey and O'Malley framework. Peer-reviewed studies and clinical guidelines addressing acute confusional states in hospitalized TBI adults were included. Data extraction focused on terminology, assessment practices, and correspondence with definitions.

RESULTS

Thirty-four studies were included. The most frequently reported terms were post-traumatic amnesia (PTA; n = 18), agitation (n = 11), delirium (n = 5), and post-traumatic confusional state (PTCS; n = 2). PTA was described as a transient state, reflecting daily assessment using unimodal cognitive screening tools rather than a broader recovery phase. It was characterized by amnesia and disorientation after sedation, aligning with international cognitive rehabilitation guidelines (INCOG 2.0), although additional features were reported. Agitation, also described as a state, involved fluctuating motor restlessness, impulsivity, aggression, and intense emotions, often without significant cognitive impairment, partially aligning with Cohen-Mansfield definition. Delirium was conceptualized as a syndrome encompassing disturbances across cognitive, attentional, behavioral, psycho-affective, and perceptual domains, and was assessed using multicomponent instruments, consistent with Diagnostic & Statistical Manual of Mental Disorders (DSM-5). PTCS was described as a transitional period during early recovery of consciousness, assessed using a multidimensional observational tool, and characterized by attentional and executive disturbances, such as disorientation, slowed processing, attention deficits, as well as fluctuating emotional and behavioral responses, consistent with the case definition.

CONCLUSION

Although overlapping features exist, PTA, agitation, delirium, and PTCS differ in underlying constructs and temporal framing. Refining definitions to better integrate behavioral and psycho-affective features and clarify transitional phases may improve conceptual and diagnostic clarity in acute TBI.