Date of Award

Spring 5-2023

Document Type

DNP Project

Project Team Faculty Member

April Schmidt

Project Team Faculty Member

Wesley Gallagher


TBI, PSH, neurostorming, Brain Injury, Paroxysmal Sympathetic Hyperactivity, Traumatic Brain Injury



Background: Paroxysmal sympathetic hyperactivity (PSH) can occur in patients with acutely acquired brain injury and is associated with mortality, poor clinical outcomes, prolonged hospitalizations, physical disability, and increased healthcare costs. The most common cause of PSH syndrome is traumatic brain injury (TBI). Symptoms consist of hyperthermia, diaphoresis, arterial hypertension, tachycardia, tachypnea, and extremity motor dystonic posturing, often in response to evoked stimuli and occurs in 8% to 33% of TBI patients. Critical care nurses are at the forefront of providing direct patient care to TBI patients and are often the first to identify PSH.

Purpose: The objective of this quality improvement project (QI) was to comprehensively evaluate the literature and provide evidence-based information regarding PSH to nurses, advanced practice providers, residents, and trauma/surgical critical care attendings who deliver care to TBI patients in a surgical trauma intensive care unit (ICU).

Methods: An integrative literature review was performed, PowerPoint was created to conduct seminars, and pre-and post-test analyses were obtained to evaluate knowledge attainment of the management of PSH. The overall goal of the educational seminars was to increase scores by >20% for adequate knowledge attainment, which was obtained. Limitations: high acuity patients, staffing schedules, seminar timing, and lack of perceived educational need by providers.

Conclusion: This QI project identified a gap in clinical knowledge and practice surrounding PSH in TBIs. Continuous education on PSH is imperative to promote early identification and timely management for prevention of secondary brain injury and worsening healthcare outcomes in this complex patient population.

Author Contact Information

Randi Rockwell

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