Early Fever As a Predictor of Paroxysmal Sympathetic Hyperactivity in Traumatic Brain Injury.

PSH was diagnosed by the treating team, and the formal diagnostic criteria available at the time of analysis did not inform the original diagnosis, so some patients may have been mislabelled or missed. The modified Clinical Feature Severity Scale was built from chart data, and sweating and posturing were often not reliably recorded, so the original scale could not be used as intended. Scores were recorded without regard to therapy, so scheduled fever treatments such as acetaminophen or cooling may have affected the temperature scores. Only patients with complete five-day data were analysed, and the sample was small, which may limit generalizability. Positive cultures were used to identify infection, but not all infections yield positive cultures, so infection could not definitely be excluded as a confound. The fever analysis was exploratory and needs validation in other cohorts. No long-term outcome data were available.

The authors report no conflicts of interest. The article is listed as NIH extramural research support.

Do not conclude that early fever causes PSH or that the modified Clinical Feature Severity Scale can diagnose PSH. The study found associations in a chart review, PSH was diagnosed clinically without formal criteria, infection was not definitely excluded, and the modified scale is not intended to make the diagnosis.