Early Fever As a Predictor of Paroxysmal Sympathetic Hyperactivity in Traumatic Brain Injury

• Published in: The journal of head trauma rehabilitation Vol. 32; no. 5; p. E50
• Main Authors: Hinson, Holly E, Schreiber, Martin A, Laurie, Amber L, Baguley, Ian J, Bourdette, Dennis, Ling, Geoffrey S F
• Format: Journal Article
• Language: English
• Published: United States 01.09.2017
• Subjects: Adult; Autonomic Nervous System Diseases - diagnosis; Autonomic Nervous System Diseases - epidemiology; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - epidemiology; Brain Injuries, Traumatic - therapy; Cohort Studies; Comorbidity; Female; Fever - diagnosis; Fever - epidemiology; Glasgow Coma Scale; Humans; Hyperkinesis - diagnosis; Hyperkinesis - epidemiology; Injury Severity Score; Male; Middle Aged; Monitoring, Physiologic - methods; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Statistics, Nonparametric; Survival Rate
• ISSN: 1550-509X
• DOI: 10.1097/htr.0000000000000271

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. 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). The Modified Clinical Feature Severity Scale (mCFSS) was applied to each participant once daily for the first 5 days of hospitalization. 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). Early fever after TBI may signal impending autonomic dysfunction.