Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study
Introduction: Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. In addition, TBI may cause paroxysmal sympathetic hyperactivity (PSH), which is associated with poor clinical outcomes. This study aimed to evaluate the safety and effectiveness of clonidine in patien...
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| Veröffentlicht in: | Science progress (1916) 2023-10, Vol.106 (4), p.368504231201298-368504231201298 |
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| creator | Alshaya, Abdulrahman I Aldhaeefi, Mohammed Alodhaiyan, Nada Alqahtani, Maha Althewaibi, Sarah Alshahrani, Wala Al Sulaiman, Khalid Al Harbi, Shmeylan A. Vishwakarma, Ramesh Aldabbagh, Tariq |
| description | Introduction:
Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. In addition, TBI may cause paroxysmal sympathetic hyperactivity (PSH), which is associated with poor clinical outcomes. This study aimed to evaluate the safety and effectiveness of clonidine in patients with TBI and suspected PSH.
Methods:
A retrospective cohort study for critically ill patients with TBI with suspected PSH admitted to intensive care units (ICUs) from 1 May 2016 to 31 January 2020 at a tertiary academic medical center. Eligible patients were categorized based on clonidine use during their ICU stay (Clonidine group vs. Control group). The primary outcome was the improvement in functional outcomes during ICU stay, defined by a delta Glasgow Coma Score (GCS). Secondary outcomes included ICU and hospital length of stay, heart rate variation, and 90-day mortality.
Results:
A total of 2915 patients were screened, of which 169 were included. Based on multiple regression analysis, patients who received clonidine showed better improvement in functional outcomes by a higher mean delta GCS than patients who did not (Beta Coeff. 0.41; CI: 0.07 – 0.74; P = 0.02). In addition, the patient's GCS upon ICU discharge and IV opioids requirement on day three were higher in the clonidine group than control (beta coefficient (95% CI): 0.18 (0.03, 0.32); p = 0.02 and beta coefficient (95% CI): 1.38 (0.24, 2.52); p = 0.02, respectively). No statistical differences were observed in any of the other secondary outcomes after adjusting for confounders.
Conclusion:
This study found that patients who received clonidine had better functional outcomes during their ICU stay, as shown by their delta GCS than those who did not. Other outcomes were similar between the groups. More data are needed to explore the role of clonidine in patients with TBI with suspected PSH. |
| doi_str_mv | 10.1177/00368504231201298 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2886941026</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_00368504231201298</sage_id><sourcerecordid>2886941026</sourcerecordid><originalsourceid>FETCH-LOGICAL-c340t-6407f3c89ddeda211537120d5a2632d4fc877bc464d5278ac6ecf01902137c663</originalsourceid><addsrcrecordid>eNp1kc1u1DAURi0EEkPhAdhZYsMmU__FTthVowKVKnVT1pFrXzMeJXawHdS8DY-KwyAhUXXlxT3fsf1dhN5TsqdUqUtCuOxaIhinjFDWdy_QjhGhGkUlf4l227zZgNfoTc4nQmhLZbdDvw5jDN76ADhrB2XFOlgMzoEp_icEyBn7gMsR8KSD_g4ThIKjw3nJc2XA4lmn-LjmSY84r9OsK1u8wcd1hqQ3i6_WOebSlKSXSW_Dh6Sr1YfTktZP-AonKCn-EdZLsYnHmArOZbHrW_TK6THDu7_nBfr2-fr-8LW5vftyc7i6bQwXpDRSEOW46XprwWpGactVbcK2mknOrHCmU-rBCClsy1SnjQTjCO0Jo1wZKfkF-nj2zin-WCCXYfLZwDjqAHHJA-s62QtK2IZ--A89xSWF-rqB9bV0zkW_UfRMmfqznMANc_KTTutAybDtbHiys5rZnzO5Nv3P-nzgN5a4mfo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2920433496</pqid></control><display><type>article</type><title>Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study</title><source>Sage Journals GOLD Open Access 2024</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Alshaya, Abdulrahman I ; Aldhaeefi, Mohammed ; Alodhaiyan, Nada ; Alqahtani, Maha ; Althewaibi, Sarah ; Alshahrani, Wala ; Al Sulaiman, Khalid ; Al Harbi, Shmeylan A. ; Vishwakarma, Ramesh ; Aldabbagh, Tariq</creator><creatorcontrib>Alshaya, Abdulrahman I ; Aldhaeefi, Mohammed ; Alodhaiyan, Nada ; Alqahtani, Maha ; Althewaibi, Sarah ; Alshahrani, Wala ; Al Sulaiman, Khalid ; Al Harbi, Shmeylan A. ; Vishwakarma, Ramesh ; Aldabbagh, Tariq</creatorcontrib><description>Introduction:
Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. In addition, TBI may cause paroxysmal sympathetic hyperactivity (PSH), which is associated with poor clinical outcomes. This study aimed to evaluate the safety and effectiveness of clonidine in patients with TBI and suspected PSH.
Methods:
A retrospective cohort study for critically ill patients with TBI with suspected PSH admitted to intensive care units (ICUs) from 1 May 2016 to 31 January 2020 at a tertiary academic medical center. Eligible patients were categorized based on clonidine use during their ICU stay (Clonidine group vs. Control group). The primary outcome was the improvement in functional outcomes during ICU stay, defined by a delta Glasgow Coma Score (GCS). Secondary outcomes included ICU and hospital length of stay, heart rate variation, and 90-day mortality.
Results:
A total of 2915 patients were screened, of which 169 were included. Based on multiple regression analysis, patients who received clonidine showed better improvement in functional outcomes by a higher mean delta GCS than patients who did not (Beta Coeff. 0.41; CI: 0.07 – 0.74; P = 0.02). In addition, the patient's GCS upon ICU discharge and IV opioids requirement on day three were higher in the clonidine group than control (beta coefficient (95% CI): 0.18 (0.03, 0.32); p = 0.02 and beta coefficient (95% CI): 1.38 (0.24, 2.52); p = 0.02, respectively). No statistical differences were observed in any of the other secondary outcomes after adjusting for confounders.
Conclusion:
This study found that patients who received clonidine had better functional outcomes during their ICU stay, as shown by their delta GCS than those who did not. Other outcomes were similar between the groups. More data are needed to explore the role of clonidine in patients with TBI with suspected PSH.</description><identifier>ISSN: 0036-8504</identifier><identifier>EISSN: 2047-7163</identifier><identifier>DOI: 10.1177/00368504231201298</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Brain ; Clonidine ; Cohort analysis ; Effectiveness ; Head injuries ; Health care facilities ; Heart rate ; Hospitals ; Hyperactivity ; Intensive care units ; Morbidity ; Mortality ; Multiple regression analysis ; Narcotics ; Patients ; Safety ; Statistical analysis ; Traumatic brain injury</subject><ispartof>Science progress (1916), 2023-10, Vol.106 (4), p.368504231201298-368504231201298</ispartof><rights>The Author(s) 2023</rights><rights>2023. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/ ) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage ). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c340t-6407f3c89ddeda211537120d5a2632d4fc877bc464d5278ac6ecf01902137c663</cites><orcidid>0000-0002-5985-9149 ; 0000-0002-5262-5841 ; 0000-0002-5547-2043</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00368504231201298$$EPDF$$P50$$Gsage$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00368504231201298$$EHTML$$P50$$Gsage$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,864,21966,27853,27924,27925,44945,45333</link.rule.ids></links><search><creatorcontrib>Alshaya, Abdulrahman I</creatorcontrib><creatorcontrib>Aldhaeefi, Mohammed</creatorcontrib><creatorcontrib>Alodhaiyan, Nada</creatorcontrib><creatorcontrib>Alqahtani, Maha</creatorcontrib><creatorcontrib>Althewaibi, Sarah</creatorcontrib><creatorcontrib>Alshahrani, Wala</creatorcontrib><creatorcontrib>Al Sulaiman, Khalid</creatorcontrib><creatorcontrib>Al Harbi, Shmeylan A.</creatorcontrib><creatorcontrib>Vishwakarma, Ramesh</creatorcontrib><creatorcontrib>Aldabbagh, Tariq</creatorcontrib><title>Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study</title><title>Science progress (1916)</title><description>Introduction:
Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. In addition, TBI may cause paroxysmal sympathetic hyperactivity (PSH), which is associated with poor clinical outcomes. This study aimed to evaluate the safety and effectiveness of clonidine in patients with TBI and suspected PSH.
Methods:
A retrospective cohort study for critically ill patients with TBI with suspected PSH admitted to intensive care units (ICUs) from 1 May 2016 to 31 January 2020 at a tertiary academic medical center. Eligible patients were categorized based on clonidine use during their ICU stay (Clonidine group vs. Control group). The primary outcome was the improvement in functional outcomes during ICU stay, defined by a delta Glasgow Coma Score (GCS). Secondary outcomes included ICU and hospital length of stay, heart rate variation, and 90-day mortality.
Results:
A total of 2915 patients were screened, of which 169 were included. Based on multiple regression analysis, patients who received clonidine showed better improvement in functional outcomes by a higher mean delta GCS than patients who did not (Beta Coeff. 0.41; CI: 0.07 – 0.74; P = 0.02). In addition, the patient's GCS upon ICU discharge and IV opioids requirement on day three were higher in the clonidine group than control (beta coefficient (95% CI): 0.18 (0.03, 0.32); p = 0.02 and beta coefficient (95% CI): 1.38 (0.24, 2.52); p = 0.02, respectively). No statistical differences were observed in any of the other secondary outcomes after adjusting for confounders.
Conclusion:
This study found that patients who received clonidine had better functional outcomes during their ICU stay, as shown by their delta GCS than those who did not. Other outcomes were similar between the groups. More data are needed to explore the role of clonidine in patients with TBI with suspected PSH.</description><subject>Brain</subject><subject>Clonidine</subject><subject>Cohort analysis</subject><subject>Effectiveness</subject><subject>Head injuries</subject><subject>Health care facilities</subject><subject>Heart rate</subject><subject>Hospitals</subject><subject>Hyperactivity</subject><subject>Intensive care units</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Multiple regression analysis</subject><subject>Narcotics</subject><subject>Patients</subject><subject>Safety</subject><subject>Statistical analysis</subject><subject>Traumatic brain injury</subject><issn>0036-8504</issn><issn>2047-7163</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><recordid>eNp1kc1u1DAURi0EEkPhAdhZYsMmU__FTthVowKVKnVT1pFrXzMeJXawHdS8DY-KwyAhUXXlxT3fsf1dhN5TsqdUqUtCuOxaIhinjFDWdy_QjhGhGkUlf4l227zZgNfoTc4nQmhLZbdDvw5jDN76ADhrB2XFOlgMzoEp_icEyBn7gMsR8KSD_g4ThIKjw3nJc2XA4lmn-LjmSY84r9OsK1u8wcd1hqQ3i6_WOebSlKSXSW_Dh6Sr1YfTktZP-AonKCn-EdZLsYnHmArOZbHrW_TK6THDu7_nBfr2-fr-8LW5vftyc7i6bQwXpDRSEOW46XprwWpGactVbcK2mknOrHCmU-rBCClsy1SnjQTjCO0Jo1wZKfkF-nj2zin-WCCXYfLZwDjqAHHJA-s62QtK2IZ--A89xSWF-rqB9bV0zkW_UfRMmfqznMANc_KTTutAybDtbHiys5rZnzO5Nv3P-nzgN5a4mfo</recordid><startdate>202310</startdate><enddate>202310</enddate><creator>Alshaya, Abdulrahman I</creator><creator>Aldhaeefi, Mohammed</creator><creator>Alodhaiyan, Nada</creator><creator>Alqahtani, Maha</creator><creator>Althewaibi, Sarah</creator><creator>Alshahrani, Wala</creator><creator>Al Sulaiman, Khalid</creator><creator>Al Harbi, Shmeylan A.</creator><creator>Vishwakarma, Ramesh</creator><creator>Aldabbagh, Tariq</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>F28</scope><scope>FR3</scope><scope>JQ2</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5985-9149</orcidid><orcidid>https://orcid.org/0000-0002-5262-5841</orcidid><orcidid>https://orcid.org/0000-0002-5547-2043</orcidid></search><sort><creationdate>202310</creationdate><title>Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study</title><author>Alshaya, Abdulrahman I ; Aldhaeefi, Mohammed ; Alodhaiyan, Nada ; Alqahtani, Maha ; Althewaibi, Sarah ; Alshahrani, Wala ; Al Sulaiman, Khalid ; Al Harbi, Shmeylan A. ; Vishwakarma, Ramesh ; Aldabbagh, Tariq</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c340t-6407f3c89ddeda211537120d5a2632d4fc877bc464d5278ac6ecf01902137c663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Brain</topic><topic>Clonidine</topic><topic>Cohort analysis</topic><topic>Effectiveness</topic><topic>Head injuries</topic><topic>Health care facilities</topic><topic>Heart rate</topic><topic>Hospitals</topic><topic>Hyperactivity</topic><topic>Intensive care units</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Multiple regression analysis</topic><topic>Narcotics</topic><topic>Patients</topic><topic>Safety</topic><topic>Statistical analysis</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alshaya, Abdulrahman I</creatorcontrib><creatorcontrib>Aldhaeefi, Mohammed</creatorcontrib><creatorcontrib>Alodhaiyan, Nada</creatorcontrib><creatorcontrib>Alqahtani, Maha</creatorcontrib><creatorcontrib>Althewaibi, Sarah</creatorcontrib><creatorcontrib>Alshahrani, Wala</creatorcontrib><creatorcontrib>Al Sulaiman, Khalid</creatorcontrib><creatorcontrib>Al Harbi, Shmeylan A.</creatorcontrib><creatorcontrib>Vishwakarma, Ramesh</creatorcontrib><creatorcontrib>Aldabbagh, Tariq</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>ANTE: Abstracts in New Technology & Engineering</collection><collection>Engineering Research Database</collection><collection>ProQuest Computer Science Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Science progress (1916)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alshaya, Abdulrahman I</au><au>Aldhaeefi, Mohammed</au><au>Alodhaiyan, Nada</au><au>Alqahtani, Maha</au><au>Althewaibi, Sarah</au><au>Alshahrani, Wala</au><au>Al Sulaiman, Khalid</au><au>Al Harbi, Shmeylan A.</au><au>Vishwakarma, Ramesh</au><au>Aldabbagh, Tariq</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study</atitle><jtitle>Science progress (1916)</jtitle><date>2023-10</date><risdate>2023</risdate><volume>106</volume><issue>4</issue><spage>368504231201298</spage><epage>368504231201298</epage><pages>368504231201298-368504231201298</pages><issn>0036-8504</issn><eissn>2047-7163</eissn><abstract>Introduction:
Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. In addition, TBI may cause paroxysmal sympathetic hyperactivity (PSH), which is associated with poor clinical outcomes. This study aimed to evaluate the safety and effectiveness of clonidine in patients with TBI and suspected PSH.
Methods:
A retrospective cohort study for critically ill patients with TBI with suspected PSH admitted to intensive care units (ICUs) from 1 May 2016 to 31 January 2020 at a tertiary academic medical center. Eligible patients were categorized based on clonidine use during their ICU stay (Clonidine group vs. Control group). The primary outcome was the improvement in functional outcomes during ICU stay, defined by a delta Glasgow Coma Score (GCS). Secondary outcomes included ICU and hospital length of stay, heart rate variation, and 90-day mortality.
Results:
A total of 2915 patients were screened, of which 169 were included. Based on multiple regression analysis, patients who received clonidine showed better improvement in functional outcomes by a higher mean delta GCS than patients who did not (Beta Coeff. 0.41; CI: 0.07 – 0.74; P = 0.02). In addition, the patient's GCS upon ICU discharge and IV opioids requirement on day three were higher in the clonidine group than control (beta coefficient (95% CI): 0.18 (0.03, 0.32); p = 0.02 and beta coefficient (95% CI): 1.38 (0.24, 2.52); p = 0.02, respectively). No statistical differences were observed in any of the other secondary outcomes after adjusting for confounders.
Conclusion:
This study found that patients who received clonidine had better functional outcomes during their ICU stay, as shown by their delta GCS than those who did not. Other outcomes were similar between the groups. More data are needed to explore the role of clonidine in patients with TBI with suspected PSH.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><doi>10.1177/00368504231201298</doi><orcidid>https://orcid.org/0000-0002-5985-9149</orcidid><orcidid>https://orcid.org/0000-0002-5262-5841</orcidid><orcidid>https://orcid.org/0000-0002-5547-2043</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Sage Journals GOLD Open Access 2024; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Brain Clonidine Cohort analysis Effectiveness Head injuries Health care facilities Heart rate Hospitals Hyperactivity Intensive care units Morbidity Mortality Multiple regression analysis Narcotics Patients Safety Statistical analysis Traumatic brain injury |
| title | Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study |
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