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Abstract Details

Orthostatic Vitals as a Diagnostic Tool for Sport-Related Concussion
Neuro Trauma, Critical Care, and Sports Neurology
P10 - Poster Session 10 (5:30 PM-6:30 PM)
5-005

To determine if there is an orthostatic vitals signature that is unique to acute sport related concussion that would help with the diagnosis of concussion.
Sport related concussion (SRC) is a clinical diagnosis made in the setting of an injury mechanism and history consistent with concussion, post-concussion symptoms, and a neurologic exam. To date there have been limited clinical diagnostic tools to aid in the diagnosis of SRC. Transient autonomic dysfunction has consistently been seen after SRC in the form of changes in R-R variability that resolves with clinical resolution of symptoms. However R-R variability requires an EKG, and expertise both difficult in a clinical setting. We hypothesized that autonomic changes after SRC can be measured through the conventional clinical tool of orthostatic vitals.
Prospective recruitment of 150 SRC patients and 50 orthopedic injuries without SRC that were less than 30 days out from their injury, and 50 normal athlete controls that have sustained neither SRC or orthopedic injury. Orthostatic vitals were checked manually with blood pressure (BP) and heart rate (HR) being recorded lying down, standing, and standing for 2 minutes. Patients were considered positive for orthostatic changes at two minutes standing if HR increased greater than 20 beats per minute or BP increased by 20 points compared to baseline lying down recorded numbers.
53% of SRC patients (79/150) had positive orthostatic changes compared to 30% (15/50) of orthopedic injured and 28% (14/50) of baseline control athletes. 97% (77/79) of SRC patients had HR change greater than 20 BPM as the diagnostic change in orthostatic vitals.
Acute SRC has a unique orthostatic signature of sustained increased heart rate during orthostatic vital testing not seen in normal athletes or orthopedic injuries that could be a clinically useful diagnostic marker for concussion diagnosis. 
Authors/Disclosures
Andrew R. Sas, MD, PhD (Ohio State University)
PRESENTER 		Dr. Sas has nothing to disclose.
Aleah Gillenkirk No disclosure on file
Michael Popovich, MD (NCAC) Dr. Popovich has nothing to disclose.
Andrea Almeida, MD (University of Michigan Department of Neurology) Dr. Almeida has nothing to disclose.
James T. Eckner, MD (University of Michigan Dept of PM&R) An immediate family member of Dr. Eckner has received personal compensation for serving as an employee of Autism Alliance of Michigan. The institution of Dr. Eckner has received research support from NIH. The institution of Dr. Eckner has received research support from Department of Defense. Dr. Eckner has received intellectual property interests from a discovery or technology relating to health care. Dr. Eckner has received personal compensation in the range of $500-$4,999 for serving as a CARE Consortium Publication Committee Member with Indiana University. Dr. Eckner has received personal compensation in the range of $0-$499 for serving as a Â鶹´«Ã½Ó³»­al Content Contributor with Move United.
Ingrid Ichesco No disclosure on file
No disclosure on file
Matthew T. Lorincz, MD, PhD (University of Michigan-NCAC Neurology) Dr. Lorincz has received personal compensation for serving as an employee of Alexion. Dr. Lorincz has received personal compensation for serving as an employee of Orphalon . Dr. Lorincz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Lorincz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Orphalon . Dr. Lorincz has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink Neurology. The institution of Dr. Lorincz has received research support from Alexion.