TY - JOUR
T1 - Early fever as a predictor of paroxysmal sympathetic hyperactivity in traumatic brain injury
AU - Hinson, Holly E.
AU - Schreiber, Martin A.
AU - Laurie, Amber L.
AU - Baguley, Ian J.
AU - Bourdette, Dennis
AU - Ling, Geoffrey S. F.
PY - 2017
Y1 - 2017
N2 - 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.
AB - 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.
KW - autonomic instability
KW - fever
KW - paroxysmal sympathetic hyperactivity
KW - sympathetic storms
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85008318983&partnerID=8YFLogxK
U2 - 10.1097/HTR.0000000000000271
DO - 10.1097/HTR.0000000000000271
M3 - Article
C2 - 28060200
AN - SCOPUS:85008318983
SN - 0885-9701
VL - 32
SP - E50–E54
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
IS - 5
ER -