Predicting outcome of acquired brain injury by the evolution of Paroxysmal Sympathetic Hyperactivity signs

In this multicenter study, we provide a systematic evaluation of the clinical variability associated with paroxysmal sympathetic hyperactivity (PSH) in patients with acquired brain injury (ABI) to determine how these signs can impact outcomes. A total of 156 ABI patients with a disorder of consciousness (DoOC) were admitted to neurorehabilitation subacute units (IRU) and evaluated at baseline (T0), after 4 months from event (T1) and at discharge (T2). The outcome measure was the Glasgow outcome scale-extended, while age, sex, etiology, Coma Recovery Scale-revised (CRS-r), Rancho Los Amigos Scale (RLAS), early rehabilitation Barthel index (ERBI), PSH-assessment measure (PSH-AM) scores and other clinical features were considered as predictive factors. A machine learning (ML) approach was used to identify the best predictive model of clinical outcomes. The etiology was predominantly vascular (50.8%), followed by traumatic (36.2%). At admission, the prevalence of PSH was 31.3%, which decreased to 16.6% and 4.4% at T1 and T2, respectively. At T2, 2.8% were dead, 61.1% had a full recovery of consciousness, whereas 36.1% remained in VS or MCS. A Support Vector Machine (SVM) SVM-based ML approach provides the best model with 82% accuracy in predicting outcomes. Analysis of variable importance shows that the most important clinical factors influencing the outcome are the PSH-AM scores measured at T0 and T1, together with neurological diagnosis, CRS-r and RLAS scores measured at T0. This joint multicenter effort provides a comprehensive picture of the clinical impact of the PSH signs in ABI patients, demonstrating its predictive value in comparison with other well-known clinical measurements.