| Autor: |
Lucca LF; S. Anna Institute, Crotone, Italy., De Tanti A; Cardinal Ferrari Rehabilitation Centre, Fontanellato (PR), Italy., Cava F; Rehabilitation Institute Montecatone, Montecatone Imola (BO), Italy., Romoli A; IRCCS-don Carlo Gnocchi Foundation, Firenze, Italy., Formisano R; IRCCS Santa Lucia Foundation, Neurorehabilitation 2 Unit, Roma, Italy., Scarponi F; Department of Rehabilitation, San Giovanni Battista Hospital, Foligno (PG), Italy., Estraneo A; IRCCS-don Carlo Gnocchi Foundation, Firenze, Italy.; Neurology Unit, SM della Pietà General Hospital, Nola, Italy., Frattini D; Department of Rehabilitation, Vimercate Hospital, Vimercate (MB), Italy., Tonin P; S. Anna Institute, Crotone, Italy., Bertolino C; Cardinal Ferrari Rehabilitation Centre, Fontanellato (PR), Italy., Salucci P; Rehabilitation Institute Montecatone, Montecatone Imola (BO), Italy., Hakiki B; IRCCS-don Carlo Gnocchi Foundation, Firenze, Italy., D'Ippolito M; IRCCS Santa Lucia Foundation, Neurorehabilitation 2 Unit, Roma, Italy., Zampolini M; Department of Rehabilitation, San Giovanni Battista Hospital, Foligno (PG), Italy., Masotta O; Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A., Lab for DoC Study, Telese Terme (BN), Italy., Premoselli S; Department of Rehabilitation, Vimercate Hospital, Vimercate (MB), Italy., Interlenghi M; DeepTrace Technologies S.R.L., Milan, Italy., Salvatore C; Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria 15, 27100 Pavia, Italy.; DeepTrace Technologies S.R.L., Milan, Italy., Polidori A; DeepTrace Technologies S.R.L., Milan, Italy., Cerasa A; Institute for Biomedical Research and Innovation, National Research Council, Mangone (CS), Italy. |
| Abstrakt: |
In this multi-center 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 (DoC) were admitted to neurorehabilitation subacute units (intensive rehabilitation unit; 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, whereas 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, 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 and 61.1% had a full recovery of consciousness, whereas 36.1% remained in VS or MCS. A support vector machine (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 multi-center effort provides a comprehensive picture of the clinical impact of PSH signs in ABI patients, demonstrating its predictive value in comparison with other well-known clinical measurements. |
