Paroxysmal sympathetic hyperactivity in severe traumatic brain injury

Abstract

Presence of PSH in patients with severe TBI was associated with prolonged hospital stay, poorer DRS at discharge, more deaths, and unfavorable outcome. The number of symptoms of PSH had a significant effect on outcome at 6 months.

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

“…Given that further assessment and inspection due to persistent symptoms is necessary in the treatment of patients with TBI, PSH-AM can help to avoid misdiagnosis, enhance diagnostic efficiency, save time, and reduce economic costs. The prospective predictive value of the PSH-AM tool has been confirmed in sensitivity/specificity analysis, showing higher sensitivity, though limited specificity (10). A recent retrospective analysis suggested that the incidence of diagnosed PSH cases in TBI patients was reduced from 32 to 18%, compared with previous studies, using this tool (59).…”

“…Previous and recent cases provide evidence that PSH-AM can not only serve as reliable diagnostic criteria, but also stratify the severity of PSH (10,57). The tool is able to dynamically monitor the evolution of individual PSH patients' clinical status, and is also valuable in diagnosing PSH in different types of brain trauma [e.g., diffuse axonal injury; (57,58)].…”

“…However, findings from other studies have suggested that a diagnosis of PSH in TBI patients was associated with longer hospitalization periods-approximately added at least 14 days-and worse clinical outcome had significantly lower motor scores and worse Glasgow Outcome Scale scores. The cause of increased mortality of PSH in severe TBI patients may result from those who did not respond to treatments rather than the complication itself, which leads to a prolonged duration of this complication, resulting in metabolic disorders or malnutrition and the deterioration of neurological condition occurring eventually (10,11). However, a most recent casecontrol study, which was not consistent with regard to the effects of outcomes, revealed that the occurrence of PSH symptoms was not associated with more complications and higher mortality (12).…”

Paroxysmal Sympathetic Hyperactivity

“…1,2 Prognosis PSH is associated with worse clinical outcomes after TBI, both short-term and long-term. 1,3,5,12,14 Prognosis is also worse in pediatric patients with TBI who have PSH. 35 Yet, it is unclear whether this association of PSH with worse prognosis is due to the preferential occurrence of PSH in patients with more severe brain injury (in which case PSH would be only a surrogate marker for disease severity rather than a factor influencing the prognosis per se) or to a direct detrimental effect of PSH on prognosis.…”

“…2 Also, if untreated, PSH may worsen over time and may cause serious secondary complications. 3 While formal evidence on treatment interventions is scant and lacks methodological quality, PSH is a treatable disorder. Adjustments in supportive care and adequate pharmacological interventions can often substantially mitigate the condition.…”