Abstract Introduction Paroxysmal Sympathetic Hyperactivity (PSH) is an under-recognized condition in pediatric patients, particularly those
Abstract Introduction Paroxysmal Sympathetic Hyperactivity (PSH) is an under-recognized condition in pediatric patients, particularly those with non-traumatic brain injuries, often leading to delayed diagnosis and suboptimal management. The condition features episodic increases in sympathetic nervous system activity, which creates significant diagnostic and therapeutic challenges. This study aims to comprehensively characterize the clinical presentation, diagnostic challenges, and treatment outcomes of pediatric PSH in a tertiary care setting. Additionally, we investigate factors contributing to delayed diagnosis and assess the impact of various clinical and management variables on patient outcomes. Methods This retrospective cohort study was conducted at King Abdullah Specialist Children’s Hospital (KASCH), Riyadh, Saudi Arabia, encompassing 42 pediatric patients diagnosed with PSH between 2016 and 2023. We extracted comprehensive data from patient records, including demographic profiles, clinical presentations, diagnostic findings, and treatment outcomes. Statistical analyses were employed to identify factors influencing mortality and clinical improvement, including univariate and multivariate regression. Results The cohort had a mean age of 6.53 years, with PSH onset typically around 4.19 years. The majority (88.1%) of PSH cases stemmed from non-traumatic causes, notably hypoxic-ischemic encephalopathy (31%). Key clinical features included fever, tachycardia, and dystonia, with a significant rate of initial misdiagnosis (69%). Healthcare providers frequently administer gabapentin as a preventive medication, while they commonly use benzodiazepines for abortive therapy. Clonidine use was associated with a statistically significant reduction in mortality (P
