Early fever as a predictor of paroxysmal sympathetic hyperactivity in traumatic brain injury

Holly E. Hinson*, Martin A. Schreiber, Amber L. Laurie, Ian J. Baguley, Dennis Bourdette, Geoffrey S. F. Ling

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)


OBJECTIVE:: Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodic, hyperadrenergic alterations in vital signs after traumatic brain injury (TBI). We sought to apply an objective scale to the vital sign alterations of PSH in order to determine whether 1 element might be predictive of developing PSH. SETTING/PARTICIPANTS/DESIGN:: We conducted an observational study of consecutive TBI patients (Glasgow Coma Scale score ≤12) and monitored the cohort for clinical evidence of PSH. PSH was defined as a paroxysm of 3 or more of the following characteristics: (1) tachycardia, (2) tachypnea, (3) hypertension, (4) fever, (5) dystonia (rigidity or decerebrate posturing), and (6) diaphoresis, with no other obvious causation (ie, alcohol withdrawal, sepsis). MAIN MEASURES:: The Modified Clinical Feature Severity Scale (mCFSS) was applied to each participant once daily for the first 5 days of hospitalization. RESULTS:: Nineteen (11%) of the 167 patients met criteria for PSH. Patients with PSH had a higher 5-day cumulative mCFSS score than those without PSH (median [interquartile range] = 36 [29-42] vs 29 [22-35], P = .01). Of the 4 components of the mCFSS, elevated temperature appeared to be most predictive of the development of PSH, especially during the first 24 hours (odds ratio = 1.95; 95% confidence interval, 1.12-3.40). CONCLUSION:: Early fever after TBI may signal impending autonomic dysfunction.

Original languageEnglish
Pages (from-to)E50–E54
Number of pages5
JournalJournal of Head Trauma Rehabilitation
Issue number5
Publication statusPublished - 2017
Externally publishedYes


  • autonomic instability
  • fever
  • paroxysmal sympathetic hyperactivity
  • sympathetic storms
  • traumatic brain injury

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