Abstract Details

Title Evaluation of the Burden Paroxysmal Sympathetic Hyperactivity in Severe Traumatic Brain Injury: Characterizing the Impact on Clinical Outcomes, Resource Utilization, and Length of Stay

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 18-009

Objective To characterize the effects of PSH on TBI patient outcomes at an academic level 1 trauma center, including: hospital and ICU length of stay (LOS), disposition, total antibiotic days, antibiotic days without an infectious source, sedating medication days, and Glasgow Outcome Score-Extended (GOS-E).

Background Paroxysmal sympathetic hyperactivity (PSH) is a known complication of acquired brain injury. Traumatic brain injury (TBI) accounts for approximately 80% of PSH cases. PSH has been associated with a prolonged course in the intensive care unit (ICU) and increased mortality, though its overall effects on TBI recovery and functional outcomes are poorly characterized.

Design/Methods Study design: single-site, observational, retrospective case-control study. Participants: Severe TBI (Glasgow Coma Score (GCS) ≤ 8), adult (age ≥ 18) patients. Database: TBI registry with 12,000+ patients with linked database and electronic medical record chart review to assess relevant variables. Data were collected between 01/2024 and 10/2024. Statistics: Multiple linear regression controlling for initial GCS, age, and sex covariates.

Results An interim analysis of 122 patients was sampled between 01/2024 and 10/2024. Thirty-nine (32%) patients were excluded due to GCS > 8, age < 18, or death within 72 hours. Twenty-four cases of severe TBI with PSH (n=24, 28.9%) were included, and compared with severe TBI controls without PSH (n=43) demonstrated statistically significant differences in hospital LOS (p<0.01) and ICU LOS (p<0.01). Early, underpowered results suggest relative antibiotic and sedating medication over-utilization in TBI patients with PSH.

Conclusions Preliminary findings suggest a statistically significant association between PSH presence and increased hospital and ICU LOS in patients with severe TBI. This may be due to patient instability and provider comfort in managing episodes of PSH outside the ICU. Further investigation is warranted to characterize the impact of PSH on relevant clinical outcomes and resource utilization following TBI and other acquired brain injuries.

Authors/Disclosures
Kathleen M. Barnett, MD (UC Davis Health) PRESENTER	Dr. Barnett has nothing to disclose.
Zachary Kaufman	No disclosure on file
Ahmed Kiran, MPH	Mr. Kiran has nothing to disclose.
Simeon Zlatanov, Medical Student	Mr. Zlatanov has nothing to disclose.
Nicholas S. Race, MD, PhD	Dr. Race has nothing to disclose.
Krupa Savalia, MD	Dr. Savalia has nothing to disclose.

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