Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.



Degree Program

Nursing, PhD

Committee Chair

Smith, Sandra

Committee Co-Chair (if applicable)

Ridner, Lee

Committee Member

Ridner, Lee

Committee Member

Park, Michael

Committee Member

Hammash, Muna

Author's Keywords

traumatic brain injury; paroxysmal sympathetic hyperactivity; sympathetic storming; coma


Paroxysmal Sympathetic Hyperactivity (PSH) is a complication affecting a subset of patients with severe traumatic brain injury (TBI). It is associated with increased morbidity, longer lengths of stay, and delayed recovery (Perkes, Baguley, Nott, & Menon, 2010). The most prevalent signs and symptoms of PSH include unprovoked tachycardia, tachypnea, hypertension, dystonia, and diaphoresis (Lemke, 2007). If untreated, PSH can lead to impaired cerebral blood flow, sub-endocardial damage, dehydration, malnourishment, and contractures (Lemke, 2007). Results from this retrospective study indicate that there is no difference in intensive unit (ICU) length of stay in TBI patients with PSH compared to those without PSH. However, there was a significant difference in discharge disposition, so that patients without PSH were more likely to be discharged to a home or acute rehabilitation setting while those with PSH were more likely to be discharged to sub-acute rehabilitation or other high level medical care. Evaluation of physiologic parameters known to be abnormal in patients with PSH, indicated that in this sample, only heart rate was a significant predictor of the development of PSH. This suggests that is it reasonable to screen younger patients who exhibit signs of sympathetic hyperactivity after TBI for PSH.