Citation

Richer L, Craig W, Linsdell M, Tang K, Zemek R. J. Neurotrauma 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2023.0113

PMID

37310894

Abstract

While there is significant variability in the manifestations of persistent concussion symptoms (PCS), autonomic dysfunction has been reported to contribute to persistent concussion symptoms (PCS) and could serve as a biomarker of recovery. The objective of this study was to evaluate cardiac autonomic reflexes and autonomic function after concussion injury comparing those with prolonged concussion symptoms to those without. This is a case-control study where a non-referral population of concussed children or adolescent participants were enrolled from the Emergency Department (ED) of the Stollery Children's Hospital - a tertiary pediatric hospital in Edmonton, Alberta, Canada. Children and adolescents aged 8 through 17 years had to present with mild traumatic head injury and were diagnosed with concussion. Our study reported concussion symptoms and standardized clinical cardiac autonomic reflex testing at 4 and 12 weeks after injury. Our findings showed that twenty-eight participants with concussion completed the 4-week follow-up questionnaires and seventeen (61%) were diagnosed with PCS. Difficulty concentrating, fatigue, noise sensitivity, light sensitivity, and headache were most commonly reported at baseline among those who were later diagnosed with PCS. The mean change in HR with head-up tilt was 44.2 BPM (SD 9.1) in the non-PCS group and 46.6 BPM (SD 14.1) in the PCS group at 4 weeks and was not significant in the unadjusted (p=0.2) or adjusted analysis for age and female sex (p=0.2). Overall, 70% (19/27) had significant orthostatic tachycardia > 40 bpm, but PCS and non-PCS groups were similar. Similar results were observed among 23 participants at 12 weeks follow-up. The median maximum decrease in systolic blood pressure (SBP) with head-up tilt was -26.9 mm Hg (IQR -32.6, -22.3) in the non-PCS group and -25.1 mm Hg (IQR -32.2, -18.2) in the PCS group and not significantly different in the unadjusted (p = 0.8) or adjusted analysis (p=0.8). Overall, 19 of 26 participants (73%) demonstrated orthostatic hypotension (SBP change > 20 mm Hg) with no significant difference between PCS and non-PCS groups. Similar results were observed at 12 weeks follow-up. In conclusion, cardiac autonomic reflex responses are abnormal in most children and adolescents with a concussion injury at 4- and 12-weeks follow-up and may reflect ongoing autonomic dysfunction. However, autonomic function did not differentiate PCS, indicating that reported symptoms are insensitive to autonomic abnormalities.

Language: en

Keywords

HEAD TRAUMA; HUMAN STUDIES; RECOVERY