Table 2 Paroxysmal sympathetic hyperactivity-assessment measure (PSH-AM)

Heart rate

1–4 years: < 100

1–4 years: 110–124

1–4 years: 125–139

1–4 years: ≥ 140

5–15 years: < 100

5–15 years:110–119

5–15 years: 120–139

5–15 years: ≥ 140

16 + years: < 100

16 + years: 110–119

16 + years: 120–139

16 + years: ≥ 140

Respiratory rate

1–4 years: < 30

1–4 years: 30–34

1–4 years: 35–39

1–4 years: ≥ 40

5–15 years: < 25

5–15 years: 25–29

5–15 years: 30–34

5–15 years: ≥ 35

16 + years: < 18

16 + years: 18–23

16 + years: 24–29

16 + years: ≥ 30

Systolic blood pressure

1–4 years: < 100

1–4 years: 100–109

1–4 years: 110–119

1–4 years: ≥ 120

5–15 years: < 120

5–15 years: 120–129

5–15 years: 130–139

5–15 years: ≥ 140

16 + years: < 140

16 + years: 140–159

16 + years: 160–179

16 + years: ≥ 180

Temperature

 < 37 °C

37–37.9 °C

38–38.9 °C

 ≥ 39 °C

Diaphoresis

Normal

Mild — moist skin

Moderate — beads of sweet

Severe — profuse sweeting

Posturing during episodes

Absent

Mild — tone is easily overcome

Moderate — tone hard to overcome

Severe — inescapable hypertonia

Diagnosis likelihood tool (DLT): one point per following feature:

1) Antecedent-acquired brain injury

2) Clinical features occur simultaneously

3) Episodes are paroxysmal in nature

4) Sympathetic over-reactivity to normally non-noxious stimuli

5) The absence of parasympathetic features during episodes

6) Features persist for > 3 consecutive days

7) Features persist for > 2 weeks post brain injury

8) Two or more episodes daily

9) The absence of other presumed causes of features

10) Features persist despite treatment of alternative differential diagnoses

11) Medication administered to decrease sympathetic features