Article

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 [5 y 7 mo]) 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.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith
Press.

Langue : ANGLAIS