1025 - The Perfect Storm: Effects of Paroxysmal Sympathetic Hyperactivity on Outcomes Following Traumatic Brain Injury

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

ZK

Zach Kaufman, MD

Resident Physician
UC Davis Dept. of PM&R
Sacramento, California, United States

Co-Author(s)

AK

Ahmed M. Kiran, MPH

Medical Student
University of California, Davis
Sacramento, California, United States
NR

Nicholas Race, MD

Director of Brain Injury Medicine, Assistant Professor
UC Davis Dept. of PM&R
Sacramento, California, United States
SZ

Simeon Zlatanov, BS

Medical Student
University of California, Davis
Davis, California, United States

Submitter(s)

ZK

Zachary Kaufman, MD

University of California, Davis
Sacramento, California, United States

Objectives: To characterize the effects of PSH on various outcomes for TBI patients at an academic level 1 trauma center including: hospital and ICU length of stay (LOS), disposition, total days on antibiotics, days on antibiotics without a source of infection, days on sedating medications, and Glascow outcome score-extended (GOS-E).

Design: Study design: single-site, observational retrospective case-control study. Participants: Severe TBI (GCS ≤ 8), adult (age >18) patients. Database: A TBI registry with 12,000+ patients with linked database and EMR chart review to assess relevant variables. Data for the study were gathered from patients between 01/2024-10/2024. Statistics: Multiple linear regression controlling for initial GCS, age, and sex covariates.

Results: Interim analysis of 122 patients were sampled between 01/2024 and 10/2024. 39 (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, which when compared to severe TBI controls without PSH (n=43) demonstrated statistically significant differences in hospital LOS (p< 0.01) and ICU LOS (p< 0.01). Early, under-powered results suggest antibiotic and sedating medication relative over-utilization TBI patients with PSH.

Conclusions: Preliminary findings suggest a statistically significant relationship between presence of PSH and increased hospital and ICU LOS in severe TBI patients. This is likely due to patient instability and provider comfort managing breakthrough episodes of PSH outside of the intensive care setting. Data collection is ongoing to adequately power for other outcomes described above.