M Nadir Haider1,2, Kush S Patel1, Barry S Willer3, Victoria Videira4, Charles G Wilber1, Andrew R Mayer5,6, Christina L Master7,8, Brandon L Mariotti2, Christopher Wertz5, Eileen P Storey8, Kristy B Arbogast8, Grace Park9, Scott J Oglesbee9, Itai Bezherano1, Kenneth Aguirre1, Jesse G Fodero10, Blair D Johnson11, Rebekah Mannix12, Jeffrey C Miecznikowski13, John J Leddy1. 1. UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA. 2. Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA. 3. Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA. 4. Faculty of Dentistry, McGill University, Montreal, Canada. 5. The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, Unites States. 6. Departments of Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico. 7. Sports Medicine and Performance Center, Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 8. Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 9. Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, New Mexico. 10. Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA. 11. Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA. 12. Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA. 13. Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA.
Abstract
Objective: Concussion is associated with dysautonomia, altered blood pressure (BP) control, and may cause Orthostatic Hypotension (OH). We measured prevalence of OH using the 1-minute supine-to-standing OH Test in adolescents with concussion and controls.Participants: Adolescents within 10 days of injury (Concussion Group, n = 297, 15.0 ± 1.7 years, 59% male) were compared with controls (Control Group, n = 214, 15.0 ± 1.5 years, 58% male). Methods: BP, heart rate (HR), and complaints of lightheadedness/dizziness were measured after 2-minute supine and 1-minute standing. Control Group was assessed once. Concussion Group was assessed twice; (1) initial visit (mean 6.0 ± 3 days-since-injury) and (2) after clinical recovery (mean 46.3 ± 42 days-since-injury). Results: Initial visit; Concussion Group reported feeling lightheaded/dizzy on postural change more often than the Control Group (37% vs 4%, p < .001) but did not differ in meeting standard OH criteria (3% vs 5%, p = .32). Experiencing symptoms did not correlate with meeting OH criteria, but correlated with abnormal vestibulo-ocular reflex. After clinical recovery; Concussion Group did not differ in experiencing lightheaded/dizziness on postural change than controls (4%, p = .65). Conclusion: Adolescents commonly experience orthostatic intolerance after concussion without meeting the standard criteria for OH.
Objective: Concussion is associated with dysautonomia, altered blood pressure (BP) control, and may cause Orthostatic Hypotension (OH). We measured prevalence of OH using the 1-minute supine-to-standing OH Test in adolescents with concussion and controls.Participants: Adolescents within 10 days of injury (Concussion Group, n = 297, 15.0 ± 1.7 years, 59% male) were compared with controls (Control Group, n = 214, 15.0 ± 1.5 years, 58% male). Methods: BP, heart rate (HR), and complaints of lightheadedness/dizziness were measured after 2-minute supine and 1-minute standing. Control Group was assessed once. Concussion Group was assessed twice; (1) initial visit (mean 6.0 ± 3 days-since-injury) and (2) after clinical recovery (mean 46.3 ± 42 days-since-injury). Results: Initial visit; Concussion Group reported feeling lightheaded/dizzy on postural change more often than the Control Group (37% vs 4%, p < .001) but did not differ in meeting standard OH criteria (3% vs 5%, p = .32). Experiencing symptoms did not correlate with meeting OH criteria, but correlated with abnormal vestibulo-ocular reflex. After clinical recovery; Concussion Group did not differ in experiencing lightheaded/dizziness on postural change than controls (4%, p = .65). Conclusion: Adolescents commonly experience orthostatic intolerance after concussion without meeting the standard criteria for OH.
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