Dysautonomia after pediatric brain injury - Not rare!

Developmental Medicine and Child NeurologyDev Med Child Neurol 2012; 54(8)

Dysautonomia after pediatric brain injury.

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 University of Pittsburgh School of Medicine, Pittsburgh, PA;  The Division of Pediatric Critical Care Medicine, The Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO;  Department of Biostatistics, The University of Pittsburgh School of Public Health, Pittsburgh, PA;  Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA;  The Children's Institute of Pittsburgh, Pittsburgh, PA;  University of Pittsburgh Medical Center, Departments of Critical Care Medicine and Pediatrics, and the Safar Center for Resuscitation Research, Pittsburgh, PA, USA.

Abstract

Aim  Dysautonomia after brain injury is a diagnosis based on fever, tachypnea, hypertension, tachycardia, diaphoresis, and/or dystonia. It occurs in 8 to 33% of adults with brain injury and is associated with poor outcome. We hypothesized that children with brain injury with dysautonomia have worse outcomes and prolonged rehabilitation, and sought to determine the prevalence of dysautonomia in children and to characterize its clinical features. Method  We developed a database of children (n=249, 154 males, 95 females; mean [SD] age 11 years 10 months [5y 7mo]) with traumatic brain injury, cardiac arrest, stroke, infection of the central nervous system, or brain neoplasm admitted for rehabilitation to The Children's Institute of Pittsburgh between 2002 and 2009. Dysautonomia diagnosis, injury type, clinical signs, length of stay, and Functional Independence Measure for Children (WeeFIM) testing were extracted from medical records, and analysed for differences between groups with and without dysautonomia. Results  Dysautonomia occurred in 13% of children with brain injury (95% confidence interval 9.3-18.0%), occurring in 10% after traumatic brain injury and 31% after cardiac arrest. The combination of hypertension, diaphoresis, and dystonia best predicted a diagnosis of dysautonomia (area under the curve=0.92). Children with dysautonomia had longer stays, worse WeeFIM scores, and improved less on the score's motor component (all p≤0.001). Interpretation  Dysautonomia is common in children with brain injury and is associated with prolonged rehabilitation. Prospective study and standardized diagnostic approaches are needed to maximize outcomes.

© The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.