Background:The 6th International Consensus Statement on Concussion in Sport guidelines identified that measuring autonomic nervous system dysfunction using orthostatic vital signs (VSs) is an important part of the clinical evaluation; however, there are limited data on the frequency of autonomic nervous system dysfunction captured via orthostatic VSs after concussion.Purpose:To compare orthostatic changes in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between athletes with acute sport-related concussion (SRC) and control athletes.Study Design:Cross-sectional study; Level of evidence, 3.Methods:We compared 133 athletes (mean age, 15.3 years; age range, 8-28 years; 45.9% female) with acute SRC (<30 days after injury) with 100 control athletes (mean age, 15.7 years; age range, 10-28 years; 54.0% female). Given the broad age range eligible for study inclusion, participants were subdivided into child (younger than 13 years of age), adolescent (13-17 years of age), and adult (18 years of age and older) age groups for subanalyses. Participants completed a single standard orthostatic VS evaluation including HR, SBP, and DBP in the supine position then immediately and 2 minutes after standing. Linear regression was used to compare delayed supine-to-standing changes in HR, SBP, and DBP as a continuous variable (ΔHR, ΔSPB, and ΔDBP) between groups, and logistic regression was used to compare patients with positive orthostatic VS changes (sustained HR increase ≥30 beats per minute [bpm], SBP decrease ≥20 mm Hg, and DBP ≥10 mm Hg at 2 minutes) between groups, accounting for age and sex.Results:Between-group differences were present for delayed ΔHR (18.4 ± 12.7 bpm in patients with SRC vs 13.2 ± 11.0 bpm in controls; P = .002) and ΔSPB (–3.1 ± 6.6 bpm in patients with SRC vs –0.4 ± 6.5 bpm in controls; P = .001), with positive orthostatic HR changes present more frequently in patients with SRC (18% vs 7%; odds ratio, 2.79; P = .027). In the SRC group, a weak inverse relationship was present between age and ΔHR ( r = –0.171; P = .049), with positive orthostatic HR findings occurring primarily in the child and adolescent SRC subgroups.Conclusion:Patients with acute SRC had greater orthostatic VS changes compared with controls, the most prominent being sustained HR elevations. Clinical evaluation of autonomic change after SRC via standard orthostatic VS assessment may be a helpful clinical biomarker in the assessment of SRC, especially in children and adolescents.

中文翻译：

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运动相关性脑震荡后的直立性生命体征：一项队列研究


背景： 第 6 届运动脑震荡国际共识声明指南确定，使用直立性生命体征 （VSs） 测量自主神经系统功能障碍是临床评价的重要组成部分;然而，关于脑震荡后通过直立性 VSs 捕获的自主神经系统功能障碍频率的数据有限。目的： 比较急性运动相关性脑震荡 （SRC） 运动员和对照组运动员心率 （HR） 、收缩压 （SBP） 和舒张压 （DBP） 的直立性变化。研究设计： 横断面研究;证据水平， 3.方法： 我们比较了 133 例急性 SRC 运动员 （平均年龄 15.3 岁;年龄范围，8-28 岁;45.9% 女性） 与 100 例对照运动员 （平均年龄 15.7 岁;年龄范围，10-28 岁;54.0% 女性）。鉴于符合研究纳入条件的年龄范围广泛，参与者被细分为儿童（13岁以下）、青少年（13-17岁）和成人（18岁及以上）年龄组进行亚分析。参与者完成了一项单一的标准直立 VS 评估，包括仰卧位的 HR、SBP 和 DBP，然后立即和站立后 2 分钟。采用线性回归比较组间 HR、SBP 和 DBP 作为连续变量 （ΔHR、ΔSPB 和 ΔDBP） 的延迟仰卧位至站立变化，逻辑回归用于比较组间直立性 VS 变化阳性（持续 HR 增加 ≥每分钟 30 次 [bpm]、收缩压降低 ≥20 mm Hg）和 DBP ≥2 分钟时 10 mm Hg） 的患者， 考虑年龄和性别。结果： 延迟 ΔHR （SRC 患者 18.4 ± 12.7 bpm） 与对照组 13.2 ± 11.0 bpm 存在组间差异;P = .002） 和 ΔSPB （–3.SRC 患者 1 ± 6.6 bpm，对照组为 -0.4 ± 6.5 bpm;P = .001），阳性直立性 HR 变化在 SRC 患者中更常见 （18% vs 7%;比值比，2.79;P = .027）。在 SRC 组中，年龄和 ΔHR 之间存在弱反比关系 （r = –0.171;P = .049），阳性直立性 HR 结果主要发生在儿童和青少年 SRC 亚组中。结论： 与对照组相比，急性 SRC 患者具有更大的直立性 VS 变化，最突出的是持续的 HR 升高。通过标准直立性 VS 评估对 SRC 后自主神经变化进行临床评估可能是评估 SRC 的有用临床生物标志物，尤其是在儿童和青少年中。