Cardiac Autonomic Function is Impaired in Adolescents with Mild Traumatic Brain Injury
Bibliographic record
Abstract
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).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".