Functional Outcome of Paroxysmal Sympathetic Hyperactivity in Traumatic Brain Injury: A Prospective Observational Study

Abstract Background Paroxysmal sympathetic hyperactivity (PSH) increases morbidity after TBI but remains underdiagnosed in low- middle- income countries (LMICs). Scarcity of data has led to impression of poor outcome in PSH. Objectives To observe functional outcomes of patients with PSH using Glasgow outcome score extended (GOSE) after TBI and explore associations between PSH and tracheostomy and duration of hospitalization. Methods: This prospective single-centre observational study, over 15 months was conducted in the Neuro-intensive care unit of a tertiary care hospital in South India. Adult patients with TBI with probable or possible PSH as per PSH assessment measure (PSH- AM) were included. Demographic data, Glasgow coma scale (GCS) score on admission and discharge, tracheostomy days and duration of hospitalization were recorded. GOSE was assessed by outpatient visit or telephonically. The t-test was used to analyse group comparison. All tests were two-tailed, and a p -value of < 0.05 was considered statistically significant. Results Prevalence of PSH was 2.4% (20/838) with 18 patients analysed for functional outcome at 6 months. Mean age was 36.5 ± 14.5 years, with a male predominance. Mean GCS at admission was 5.2 ± 2.9, and mean PSH-AM score was 20.4 ± 3.0. Tracheostomy was required in 14 patients (78%). Six patients (33%) died during follow-up. Mean GOSE score improved from 2.61 ± 0.69 at discharge to 4.52 ± 1.68 at six months. Conclusions Early recognition and supportive management of PSH can enhance progressive recovery among survivors. Serial follow up is essential to track functional improvement.