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Brain Inj. 2011;25(10):925-32. doi: 10.3109/02699052.2011.589797.

Paroxysmal sympathetic hyperactivity after acquired brain injury: a review of diagnostic criteria.

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  • 1Brain Injury Rehabilitation Service, Westmead Hospital , Australia. iain.perkes@gmail.com

Abstract

PRIMARY OBJECTIVE:

To evaluate the development and usage of diagnostic criteria for paroxysmal sympathetic hyperactivity (PSH) following acquired brain injury (ABI), then comparatively analyse published criteria.

RESEARCH DESIGN:

Systematic literature review.

METHODS AND PROCEDURES:

Literature published in English language prior to 30 November 2008 was reviewed for dysautonomic syndromes following ABI, characterized by simultaneous paroxysmal autonomic hyperactivity and motor over-activity.

MAIN OUTCOME AND RESULTS:

Sixty papers presenting 349 cases of PSH were identified, with a further 21 papers providing additional information regarding the condition. Only 27 of these 81 papers (33%) utilized diagnostic criteria. There were nine novel or substantially modified diagnostic criteria sets, which were analysed further. Criteria showed strong agreement on core clinical features of PSH-heart rate (HR), blood pressure, respiratory rate, temperature, sweating, and motor hyperactivity. Most criteria sets utilized a polythetic diagnostic system and all but one indicated severity thresholds, e.g. HR >120 beats per minute. Two papers specified a minimum episode frequency and four papers required a minimum syndrome duration.

CONCLUSIONS:

Of necessity, diagnostic criteria have been developed ad hoc. The differences between criteria complicate both clinical diagnosis and the process of comparing research cohorts. These findings demarcate the need for a single set of PSH diagnostic criteria and provide the substrate for scientific consensus.

PMID:
21812584
DOI:
10.3109/02699052.2011.589797
[PubMed - indexed for MEDLINE]
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