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Cardiac Autonomic Function is Impaired in Adolescents with Mild Traumatic Brain Injury
Author(s) -
Abbott Kolten C.,
Badrov Mark B.,
Elfassy Jonah,
Moir M. Erin,
Fischer Sara A.,
Fischer Lisa K.,
Fraser Douglas D.,
Shoemaker J. Kevin
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.lb724
Subject(s) - concussion , traumatic brain injury , medicine , supine position , heart rate variability , autonomic function , neuropsychology , pediatrics , cardiology , physical therapy , poison control , heart rate , injury prevention , cognition , emergency medicine , blood pressure , psychiatry
Mild traumatic brain injury (mTBI), of which concussion is a subset, are a major pediatric public health concern. Children and adolescent populations not only report the highest incidence of concussions, but are also more likely to experience symptoms which persist beyond the 2‐week period of spontaneous healing. In order to reduce the transition of acute symptoms into long‐term negative consequences, objective diagnostic and management tools are essential. However despite increased awareness, clinicians remain reliant on subjective symptom analyses and neuropsychological evaluations to diagnose and manage concussive injuries. Furthering our understanding of the pathophysiological response of an adolescent brain following a concussive injury may provide the foundation for the development of objective biomarkers. Therefore, the purpose of this investigation was to evaluate cardiac autonomic function in adolescents acutely diagnosed with a concussion. More specifically, autonomic function was evaluated while in the supine position, via heart rate variability (HRV; time‐and frequency‐domain) and cardiovagal baroreflex sensitivity (BRS; sequence method) in 16 adolescents diagnosed with a concussion (mTBI; 11 females; 16 ± 2 yrs, 173 ± 9 cm, 69 ± 15 kg) and 16 age‐matched controls with no previous history of concussion (CTRL; 7 females; 14 ± 2 yrs, 168 ± 8 cm, 66 ± 15 kg). mTBI patients were 9 ± 4 days post‐injury and presented with a SCAT3 symptom score of 14 ± 7. Compared to CTRL, mTBI patients had significantly lower standard deviation of normal RR intervals (SDNN; 56 ± 20 vs. 88 ± 40 ms; P < 0.01, Cohen's d = 1.06) and root mean square of successive differences (RMSSD; 59 ± 27 vs. 98 ± 57 ms; P < 0.05, d = 0.94). Furthermore, in the frequency domain, both total power (3491 ± 2482 vs. 8954 ± 7932 ms 2 ; P < 0.05, d = 1.05) and high frequency power (1555 ± 1223 vs. 3644 ± 3334 ms 2 ; P < 0.05, d = 0.92) were reduced in mTBI patients compared to CTRL, while a trend for reduced low frequency power in mTBI patients was observed (989 ± 726 vs. 2986 ± 4028 ms2; P = 0.07, d = 0.84). Finally, compared to CTRL, cardiovagal BRS was lower in mTBI patients (32 ± 14 vs. 52 ± 36 ms/mmHg; P < 0.05; d = 0.81). The results of this study suggest that adolescent concussions are characterized by cardiac autonomic dysregulation. The utility of HRV and BRS to assist clinicians in the early diagnosis of adolescent concussion warrants further investigation. Support or Funding Information This work was supported by the Children's Health Research Institute (London, Canada).