Paroxysmal sympathetic hyperactivity in severe traumatic brain injury

Paroxysmal sympathetic hyperactivity (PSH) is a less-known complication of traumatic brain injury (TBI). This study was done to assess the clinical features and outcome of patients who develop PSH following severe TBI.

A prospective observational study was done on patients, admitted in the intensive care unit, for treatment of severe TBI. The clinical characteristics and outcome of patients, with and without PSH, was compared. At the time of discharge, patients were assessed with the Disability Rating Scale (DRS), and at 6 months with the Glasgow Outcome Score Extended (GOSE).

The incidence of PSH was 8 % (29/343). Tachycardia, hypertension, and sweating were seen in all of the patients. Tachypnea was seen in 24 (82.8 %), hyperthermia in 28 (96.6 %), and posturing in 13 (44.8 %) patients. Thirteen (44.8 %) patients had all six symptoms of PSH. Follow-up data were available for 23 (79.3 %) patients. At the end of 6 months, 14 (60.9 %) patients had died, seven (30.4 %) were severely disabled, and two (8.7 %) were moderately disabled. There was a significant correlation of GOSE with the number of symptoms of PSH (Spearman's rho = 0.502, p = 0.015). The patients with PSH had significantly higher DRS scores at discharge, 25.3 vs. 19.9, p < 0.001; higher mortality at 6 months 60.9 vs. 30.4 %, p < 0.001; and higher proportions with unfavorable outcome.

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.