Paroxysmal Sympathetic Hyperactivity after Acquired Brain Injury: Consensus on Conceptual Definition, Nomenclature, and Diagnostic Criteria
Paroxysmal Sympathetic Hyperactivity after Acquired Brain Injury: Consensus on Conceptual Definition, Nomenclature, and Diagnostic Criteria
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DOI：
10.1089/neu.2013.3301
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发表时间：
2014-09-01
影响因子：
4.2
通讯作者：
Hendricks, Henk T.
中科院分区：
文献类型：
--
作者：
Baguley, Ian J.;Perkes, Iain E.;Hendricks, Henk T.
获得性脑损伤后阵发性、发作性交感神经亢进综合征已被认识近60年。该项目试图简化该疾病的混乱命名法（>31个命名法），并简化9套重叠的诊断标准。采用德尔菲法，向一个具有广泛代表性的国际专家组分发了一份根据对文献的系统性审查达成共识的调查表。如果群体共识未能就其相对重要性达成一致，则放弃诊断标准，目标是达到0.8的Cronbach alpha（适合研究目的）。由此产生的标准被合并为临床和研究环境的评估措施。共识小组建议用“阵发性交感神经功能亢进”取代以前的术语来描述“在严重获得性脑损伤幸存者亚组中发现的交感神经活动[心率、血压、呼吸频率、体温、出汗]和运动[姿势]活动同时阵发性一过性增加的综合征”。参考已发表的标准，开发了11点概率诊断量表，得出可接受的Cronbach α为0.8。这11个项目被程序化，并与症状严重程度指数相结合，以产生用于成人的诊断工具（阵发性交感神经功能亢进评估措施[PSH-AM]）。建议开发儿科版本的量表，并进一步研究PSH-AM的有效性。共识的立场建立在以前的文献，以建立诊断定义和标准，这是一个重要的举措，以规范研究和管理这种情况。
A syndrome of paroxysmal, episodic sympathetic hyperactivity after acquired brain injury has been recognized for almost 60 years. This project sought to simplify the confused nomenclature for the condition (>31 eponyms) and simplify the nine overlapping sets of diagnostic criteria. A consensus-developed questionnaire based on a systematic review of the literature was circulated to a widely representative, international expert group utilizing a Delphi approach. Diagnostic criteria were dropped if group consensus failed to agree on their relative importance, with a goal of reaching a Cronbach alpha of 0.8 (suitable for research purposes). The resulting criteria were combined into an assessment measure for clinical and research settings. The consensus group recommend that the term "paroxysmal sympathetic hyperactivity'' replace previous terms to describe the "syndrome, recognised in a subgroup of survivors of severe acquired brain injury, of simultaneous, paroxysmal transient increases in sympathetic [elevated heart rate, blood pressure, respiratory rate, temperature, sweating] and motor [posturing] activity.'' An 11 point probabilistic diagnostic scale was developed with reference to published criteria, yielding an acceptable Cronbach alpha of 0.8. These 11 items were proceduralized and combined with a symptom severity index to produce a diagnostic tool for use with adults (the paroxysmal sympathetic hyperactivity assessment measure [PSH-AM]). Development of a pediatric version of the scale and further research into the validity of the PSH-AM is recommended. The consensus position builds on previous literature to establish diagnostic definitions and criteria, an important move to standardize research and management of this condition.