Overlapping Physiologic Signs of Sepsis and Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury:...

Area of Science:

• Neuroscience
• Critical Care Medicine
• Infectious Diseases

Background:

• Traumatic brain injury (TBI) can lead to paroxysmal sympathetic hyperactivity (PSH), a condition associated with poorer patient outcomes.
• Sepsis also worsens TBI outcomes and shares physiological similarities with PSH, causing diagnostic challenges.
• This study is the first to examine the interplay between PSH and infection using rigorous diagnostic standards.

Purpose of the Study:

• To investigate the diagnostic challenges and clinical implications of co-occurring PSH and infection in TBI patients.
• To determine if standard infection markers, such as SIRS criteria, can accurately identify infection in TBI patients with PSH.

Main Methods:

• A retrospective cohort study matched 77 TBI patients with PSH to 77 without PSH.
• Infection diagnoses were prospectively documented by infectious disease specialists.
• Evaluated PSH severity scores and SIRS criteria in relation to infection status.

Main Results:

• No significant difference in infection rates between PSH and control groups within the first two weeks.
• Systemic inflammatory response syndrome (SIRS) criteria were only effective in identifying infection in patients without PSH.
• Treatment for PSH and confirmed infections were initiated around the same time (median days 7 and 8, respectively).

Conclusions:

• Distinguishing sepsis from PSH in TBI patients is clinically challenging due to overlapping symptoms and unreliable standard markers.
• PSH can mimic or trigger SIRS, potentially leading to misdiagnosis and inappropriate antibiotic use.
• Multidisciplinary management and awareness of PSH diagnostic criteria are crucial for accurate diagnosis and treatment in TBI patients.