Dysautonomia after pediatric brain injury.
Dysautonomia after pediatric brain injury.
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小儿脑损伤后的功能障碍。
DOI：
10.1111/j.1469-8749.2012.04322.x
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发表时间：
2012-08
影响因子：
3.8
通讯作者：
Fink EL
中科院分区：
文献类型：
--
作者：
Kirk KA;Shoykhet M;Jeong JH;Tyler-Kabara EC;Henderson MJ;Bell MJ;Fink EL
脑损伤后的自主神经功能障碍是基于发热、呼吸急促、高血压、心动过速、出汗和/或肌张力障碍的诊断。它发生在8%至33%的脑损伤成年人中，并与预后不良有关。我们假设，脑损伤的儿童与自主神经功能障碍有更糟糕的结果和长期的康复，并试图确定儿童的自主神经功能障碍的患病率，并描述其临床特征。我们开发了一个儿童数据库（n = 249，154名男性，95名女性;平均（SD）年龄11岁10个月[5岁7个月]）创伤性脑损伤，心脏骤停，中风，中枢神经系统感染，或脑肿瘤承认匹兹堡儿童研究所康复2002年至2009年。从医疗记录中提取了自主神经功能障碍诊断、损伤类型、临床体征、住院时间和儿童功能独立性测量（Weekly）测试，并分析了有和无自主神经功能障碍组之间的差异。13%的脑损伤儿童发生自主神经功能障碍（95%置信区间9.3 - 18.0%），10%发生在创伤性脑损伤后，31%发生在心脏骤停后。高血压、出汗和肌张力障碍的组合最能预测自主神经功能障碍的诊断（曲线下面积= 0.92）。患有自主神经功能障碍的儿童住院时间更长，Weekly评分更差，运动部分评分改善较少（所有p ≤ 0.001）。自主神经功能障碍在脑损伤儿童中很常见，并与长期康复有关。需要前瞻性研究和标准化的诊断方法来最大限度地提高结果。
Dysautonomia after brain injury is a diagnosis based on fever, tachypnea, hypertension, tachycardia, diaphoresis, and/or dystonia. It occurs in 8 to 33% of brain-injured adults and is associated with poor outcome. We hypothesized that brain-injured children with dysautonomia have worse outcomes and prolonged rehabilitation, and sought to determine the prevalence of dysautonomia in children and to characterize its clinical features. We developed a database of children (n=249, 154 males, 95 females; mean (SD) age 11y 10mo [5y 7mo]) with traumatic brain injury, cardiac arrest, stroke, infection of the central nervous system, or brain neoplasm admitted to The Children’s Institute of Pittsburgh for rehabilitation 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. 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). 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.
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影响因子：
5.1
作者：
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通讯作者：
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影响因子：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1097/ta.0b013e3182127baa
发表时间：
2011-10-01
影响因子：
--
作者：
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通讯作者：
Bouaziz, Mounir