Paroxysmal Sympathetic Hyperactivity following Severe Pediatric Brain Injury

Problem Statement: Individuals that suffer from severe brain injury can develop a complicating phenomenon that appears as autonomic instability and muscle over activity and is referred to as paroxysmal sympathetic hypersensitivity (PSH). PSH following severe pediatric brain injury may be associated with a poorer recovery trajectory and quality of life.

Long-Term Goal: The broad goal for the program of research is to develop interventions aimed at improving clinical outcomes for children who have suffered a brain injury, with a particular focus on ways to mitigate symptoms for PSH.

Specific Aims:
Specific Aim 1: To describe the different characteristics between children that have suffered a severe brain injury and exhibit PSH compared with children that have suffered a severe brain injury in the absence of PSH.
Specific Aim 1.2: To describe characteristics of children who transitioned to rehabilitation following severe brain injury compared with those who do not transition to rehabilitation.
Specific Aim 1.3: To determine if there is an association with transition to rehabilitation following PSH and severe pediatric brain injury.
Specific Aim 2: To determine the influence of PSH following severe pediatric brain injury as a predictor of lower cognitive function.
Hypothesis: PSH following pediatric brain injury will be a significant predictor of lower cognitive function.
Specific Aim 3: To determine the influence of PSH following severe pediatric brain injury as a predictor of poorer motor function.
Specific Aim 4: To determine the influence of PSH following severe pediatric brain injury as a predictor of longer hospital length of stay.
Specific Aim 5: To explore nursing documentation of a PSH event and describe the clinical nursing interventions and care being provided to a child that has suffered a severe brain injury and is exhibiting PSH.

Methodology: The study used a secondary analysis of an established clinical dataset of children (N=83) who had suffered a brain injury and had not regained consciousness prior to admission to an academic children’s hospital rehabilitation center for Aims 1-4. Multiple regression models were used to estimate the effects of PSH on the continuous outcomes of motor and cognitive function and length of stay. Logistic regression was used to estimate the effect of PSH on transition to rehabilitation. To address Aim 5, ten children were randomly selected from the dataset and the nursing progress notes were reviewed using directed content analysis.

Results: The PSH group had significantly longer acute care (p=0.024) and total lengths of stay (p=0.034) compared with the non-PSH group. There was not a significant difference in cognitive and motor function or transition to rehabilitation or rehabilitation length of stay between the PSH and non-PSH groups after controlling for age and etiology of injury. The nursing progress notes revealed that the priority nursing interventions to manage these symptoms included medication administration, facilitation of family presence, and strategies to target auditory, tactile, and visual stimuli.
Conclusions: Empirically grounded interventions need to be developed and tested that achieve better outcomes for children and their families following brain injury.