Disclosures: Daniela A. Iliescu, MD: No financial relationships or conflicts of interest
Objective: Paroxysmal sympathetic hyperactivity (PSH) is a severe excessive autonomic hyperactivity in patients with acquired brain injury. Several factors lead to delayed recognition and management and hence an increase in long-term disability: poorly understood pathophysiology; existence of several diagnostic criteria/nomenclature; and anecdotal management strategies. Baseline survey of 105 hospitalists with a 50% response rate revealed that 73.1% do not feel confident diagnosing, and 84.6% do not feel confident managing PSH. Furthermore, 42.3% do not have access to resources directing management of PSH. Not surprisingly, only 8% of the monthly TBI PM&R consults are for PSH management. Our aim is to improve the comfort level of hospitalists and nurses to detect and manage PSH by 10% in 6 months, and to increase the number of PM&R consults for PSH by the same percentage.
Design: Single center prospective quality improvement study Setting : Multidisciplinary academic medical center Participants : Physicians and nurses managing patients at risk of PSH
Interventions: We performed a literature review for diagnosis and management of PSH, surveyed hospitalists, had meetings with the clinical nurse coordinator to develop guidelines and order sets for both nurses and physicians, and collaborated with pharmacist to develop drug descriptions for PSH management.
Main Outcome Measures: The reported confidence level of hospitalists and nurses in diagnosing and managing patients with PSH and the number of consults placed for PSH management
Results: Developed flowchart and corresponding order sets for nurses and hospitalists describing symptoms that indicate PSH, diagnosis tool, initial management and timeline for PM&R consult. The next steps planned are implementing these tools in the EMR according to institution regulations , educating providers to facilitate their implementation, and measuring outcomes as described above. Conclusions: Creating a guideline and EMR order sets with the help of a multidisciplinary team is the first step in developing a system for early recognition and proper management of patients with PSH.
Level of Evidence: Level II
To cite this abstract in AMA style:
Iliescu DA, Bavishi S. Model for Development of Guidelines for Paroxysmal Sympathetic Hyperactivity Management in the Acute Phase of Care: A Quality Improvement Project [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/model-for-development-of-guidelines-for-paroxysmal-sympathetic-hyperactivity-management-in-the-acute-phase-of-care-a-quality-improvement-project/. Accessed June 27, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/model-for-development-of-guidelines-for-paroxysmal-sympathetic-hyperactivity-management-in-the-acute-phase-of-care-a-quality-improvement-project/