Prognostic influence and computed tomography findings in dysautonomic crises after traumatic brain injury

Background: Dysautonomic crises represent a relatively unknown complication in patients with severe traumatic brain injury (TBI). Few studies have been undertaken of their pathophysiology and prognostic repercussions. We studied the prevalence of dysautonomic crises after TBI, their radiologic substrate, influence on the clinical course in the intensive care unit (ICU), and effect on neurologic recovery. Methods: A case-control study involving 11 patients with dysautonomic crises admitted with TBI during a span of 1 year and 26 patients admitted with TBI but no crises during the first 3 months of the same year. The initial severity was assessed from Apache 11, Glasgow Coma Scale (GCS) scores, and computed tomography (CT) during the first 24 hours. Complications were assessed by the duration of ICU stay, days on mechanical ventilation, need for tracheotomy, and number of infectious complications. Neurologic recovery was assessed with the GCS at discharge from the ICU and with the Glasgow Outcome Scale 12 months later. Results: Both groups were similar at admission. The prevalence of dysautonomic crises was 9.3%. Patients with dysautonomic crises had more focal lesions on cranial CT than patients without crises, a significantly longer ICU stay, and a tendency to have a worse level of consciousness at discharge from the ICU but not 12 months later. Conclusions: Almost 10% of patients with severe TBI have dysautonomic crises during their ICU stay. Patients with dysautonomia were more likely to have focal intraparenchymal lesions, and crises were associated with greater morbidity and a longer ICU stay. Dysautonomic crises determined a worse short-term neurologic recovery.