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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2021; 08(03): 187-191
DOI: 10.1055/s-0040-1721553
Original Article

Incidence of Paroxysmal Sympathetic Hyperactivity after Traumatic Brain Injury in a Tertiary Care ICU: A Retrospective Cohort Study

Ajit Bhardwaj
1   Department of Anaesthesia, Critical Care Command Hospital, Lucknow, Uttar Pradesh, India
,
Ganesh C. Satapathy
1   Department of Anaesthesia, Critical Care Command Hospital, Lucknow, Uttar Pradesh, India
,
Arpit Garg
1   Department of Anaesthesia, Critical Care Command Hospital, Lucknow, Uttar Pradesh, India
,
Vikas Chawla
1   Department of Anaesthesia, Critical Care Command Hospital, Lucknow, Uttar Pradesh, India
,
Kiran Jangra 
2   Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Background Paroxysmal sympathetic hyperactivity (PSH) is an understudied complication of traumatic brain injury (TBI). PSH usually presents with transient rise in sympathetic outflow, leading to increased blood pressure, heart rate, temperature, respiratory rate, sweating, and posturing activity. We retrospectively analyzed the incidence of PSH in TBI using PSH-assessment measure (PSH-AM) scale.

Methods This single-center retrospective cohort study was conducted in traumatic head injury patients admitted in the intensive care unit from January 1, 2016 to December 31, 2019 in a tertiary care center. The data was collected from the hospital database after obtaining approval from the hospital ethics committee.

Results A total of 287 patients (18–65 years of age) were admitted to intensive care unit (ICU) with TBI out of which 227 patients were analyzed who had ICU stay for more than 14 days. PSH was diagnosed in 70 (30.8%) patients. Mean age of PSH positive patients was 40 ± 18 and 49 ± 11 years for PSH negative patients (p < 0.001). The age group between 40 and 50 years had a higher incidence of PSH. The age and Glasgow coma score (GCS) were significantly associated with the occurrence of PSH. The GCS score demonstrated good accuracy for predicting the occurrence of PSH with AUC 0.83, 95% CI of 0.775 to 0.886, and a p-value of 0.001.

Conclusion We observed that the incidence of PSH was 30.8% in the patients with TBI. Age and GCS were found to have a significant association for predicting the occurrence of PSH. The patients who developed PSH had a longer length of hospital stay in ICU.

Keywords

dysautonomia - frontal lobe contusion - traumatic brain injury - Glasgow Coma Scale

Supplementary Material



Publication History

Article published online:
13 April 2021

© 2021. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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