Evidence map›Paper›PMID 37884690›Full record

ArticleNeurocritical care2024

Overlapping Physiologic Signs of Sepsis and Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury: Exploring A Clinical Conundrum.

Vanessa Rose Salasky, Sancharee Hom Chowdhury, Lujie Karen Chen, Ediel Almeida, Xiangxiang Kong, Michael Armahizer, Mehrnaz Pajoumand, Gregory M Schrank, Ronald P Rabinowitz, Gary Schwartzbauer and 3 more

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Article in Neurocritical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.4field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 7 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 2 institutions in 1 country.

Vanessa Rose SalaskyDivision of Neurocritical Care and Emergency Neurology, Department of Neurology, Program in Trauma, University of Maryland, School of Medicine, University of Maryland Medical Center, 22 S. Greene Street, G7K19, Baltimore, MD, 21201, USA.
Sancharee Hom ChowdhuryDepartment of Information Systems, University of Maryland Baltimore County, Baltimore, MD, USA.
Lujie Karen ChenDepartment of Information Systems, University of Maryland Baltimore County, Baltimore, MD, USA.
Ediel AlmeidaUniversity of Maryland School of Medicine, Baltimore, MD, USA.
Xiangxiang KongDepartment of Information Systems, University of Maryland Baltimore County, Baltimore, MD, USA.
Michael ArmahizerUniversity of Maryland School of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA.
Mehrnaz PajoumandUniversity of Maryland School of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA.
Gregory M SchrankDivision of Infectious Diseases, Department of Medicine, Program in Trauma, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
Ronald P RabinowitzDivision of Infectious Diseases, Department of Medicine, Program in Trauma, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
Gary SchwartzbauerDepartment of Neurosurgery, Program in Trauma, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
Peter HuDepartment of Anesthesiology, Program in Trauma, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
Neeraj BadjatiaDivision of Neurocritical Care and Emergency Neurology, Department of Neurology, Program in Trauma, University of Maryland, School of Medicine, University of Maryland Medical Center, 22 S. Greene Street, G7K19, Baltimore, MD, 21201, USA.
Jamie Erin PodellDivision of Neurocritical Care and Emergency Neurology, Department of Neurology, Program in Trauma, University of Maryland, School of Medicine, University of Maryland Medical Center, 22 S. Greene Street, G7K19, Baltimore, MD, 21201, USA. jpodell@som.umaryland.edu.ORCID 0000-0003-0707-2683
University of Maryland, Baltimore · USUniversity of Maryland, Baltimore County · US

Funding

Institute for Clinical and Translational Research, University of Maryland, Baltimore 1UL1TR003098
6 · The paper itself

Abstract

backgroundParoxysmal sympathetic hyperactivity (PSH) occurs in a subset of patients with traumatic brain injury (TBI) and is associated with worse outcomes. Sepsis is also associated with worse outcomes after TBI and shares several physiologic features with PSH, potentially creating diagnostic confusion and suboptimal management of each. This is the first study to directly investigate the interaction between PSH and infection using robust diagnostic criteria.

methodsWe performed a retrospective cohort study of patients with TBI admitted to a level I trauma center intensive care unit with hospital length of stay of at least 2 weeks. From January 2016 to July 2018, 77 patients diagnosed with PSH were 1:1 matched by age and Glasgow Coma Scale to 77 patients without PSH. Trauma infectious diseases subspecialists prospectively documented assessments corroborating diagnoses of infection. Extracted data including incidence, timing, classification, and anatomical source of infections were compared according to PSH diagnosis. We also evaluated daily PSH clinical feature severity scores and systemic inflammatory response syndrome (SIRS) criteria and compared values for patients with and without confirmed infection, stratified by PSH diagnosis.

resultsDuring the first 2 weeks of hospitalization, there were no differences in rates of suspected (62%) nor confirmed (48%) infection between patients with PSH and controls. Specific treatments for PSH were initiated on median hospital day 7 and for confirmed infections on median hospital day 8. SIRS criteria could identify infection only in patients who were not diagnosed with PSH.

conclusionsIn the presence of brain injury-induced autonomic nervous system dysregulation, the initiation and continuation of antimicrobial therapy is a challenging clinical decision, as standard physiologic markers of sepsis do not distinguish infected from noninfected patients with PSH, and these entities often present around the same time. Clinicians should be aware that PSH is a potential driver of SIRS, and familiarity with its diagnostic criteria as proposed by the PSH assessment measure is important. Management by a multidisciplinary team attentive to these issues may reduce rates of inappropriate antibiotic usage and misdiagnoses.

Indexed as

Brain Injuries, TraumaticSepsisAdultAgedAutonomic Nervous System DiseasesFemaleGlasgow Coma ScaleHumansMaleMiddle AgedRetrospective StudiesSystemic Inflammatory Response SyndromeAutonomic nervous system diseasesBrain injuries (traumatic)Intensive care unitsSepsisSystemic inflammatory response syndrome

Identifiers

PMID37884690
OpenAlexW4387965081

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.