Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study

Alshaya, Abdulrahman I., Aldhaeefi, Mohammed, Alodhaiyan, Nada, Alqahtani, Maha, Althewaibi, Sarah, Alshahrani, Wala, Al Sulaiman, Khalid, Al Harbi, Shmeylan A., Vishwakarma, Ramesh and Aldabbagh, Tariq (2023) Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study. Science Progress, 106 (4). pp. 1-12. ISSN 0036-8504

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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.

Item Type:	Article
Additional Information:	We want to thank all the investigators who participated in this project from the Saudi Critical Care Pharmacy Research (SCAPE) platform. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Uncontrolled Keywords:	catecholamine surge,clonidine,paroxysmal sympathetic hyperactivity,tbi,trauma,general ,/dk/atira/pure/subjectarea/asjc/1000
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Medicine and Health Sciences > Research Centres > Population Health (former - to 2025)
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	14 Apr 2026 10:35
Last Modified:	14 Apr 2026 10:35
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102771
DOI:	10.1177/00368504231201298

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