Incidence of paroxysmal sympathetic hyperactivity following traumatic brain injury using assessment tools

ABSTRACT

Introduction: A consensus statement proposed a diagnostic framework to systematise the identification of paroxysmal sympathetic hyperactivity (PSH) using the PSH-Assessment Measure (PSH-AM).

Methods: This retrospective study identified adult patients with a primary diagnosis of traumatic brain injury and a hospital length of stay >14 days. Based on PSH-AM scores, patients were grouped into ‘unlikely’, ‘possible’, or ‘probable’ PSH. For this study, ‘possible’ and ‘probable’ PSH patients were collapsed into a single group (PSH+), and resultant data were compared with ‘unlikely’ diagnoses (PSH-). PSH-AM data were assessed against clinical diagnoses to establish sensitivity and specificity data.

Results: Sixty five patients met inclusion criteria, with 45/65 (69%) categorised as either ‘possible’ or ‘probable’ PSH on the PSH-AM. Only 16 of these patients were diagnosed by clinicians. The most common symptoms triggering clinical diagnosis were tachycardia, fever and posturing. Increased respiratory rate, blood pressure or the presence of diaphoresis were not used in diagnosing PSH if the PSH-AM was not utilised. Assuming clinical assessment as the current gold standard, the PSH-AM yielded a sensitivity of 94% and a specificity of 35% when used retrospectively. Patients clinically diagnosed with PSH were discharged 5 days earlier compared to those identified by the PSH-AM.

Conclusions: The recently proposed diagnostic framework may reduce misdiagnosis, length of stay and hospitalisation costs.

KEYWORDS:

• Paroxysmal sympathetic hyperactivity
• traumatic brain injury
• autonomic dysregulation
• brain storming
• diencephalic autonomic seizures

Acknowledgements

We thank Sherouk Sharaf, Ghazaleh Ranjbar and Gin Yau for assisting us with acquisition of data.

Conflict of interest

Sophie Samuel, Monica Lee, Robert J Brown, H Alex Choi and Ian J Baguley declare that they have no conflict of interest.

Additional information

Notes on contributors

Sophie Samuel

S Samuel: study concept and design, analysis and interpretation, critical revision of the manuscript for important intellectual content.

Monica Lee

M Lee: acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content.

Robert J Brown

R Brown: analysis and interpretation, critical revision of the manuscript for important intellectual content.

Huimahn A. Choi

H Choi: analysis and interpretation, critical revision of the manuscript for important intellectual content.

Ian J Baguley

I Baguley: analysis and interpretation, critical revision of the manuscript for important intellectual content