Early changes in cerebral autoregulation among youth hospitalized after sports-related traumatic brain injury.
Monica S Vavilala, Carly K Farr, Arraya Watanitanon and 4 others
PMID 29182378WHAT IT FOUND
Five of six hospitalized youth with sports-related brain injury had impaired brain blood flow regulation within 24 hours, even when Glasgow Coma Scale was 15 and headache was present.
Key findings
01Five of six hospitalized youth with sports-related brain injury had impaired brain blood flow regulation within 24 hours of admission.
02The five patients with impaired or absent regulation had Glasgow Coma Scale 15 and headache at testing.
03Three of six patients were discharged with impaired regulation; they had left autoregulatory index 0.4 ± 0.5 versus 0.7 ± 0.3 in those discharged with normal regulation (p = 0.02) and right supine middle cerebral artery flow velocity 60 ± 4 cm/s versus 78 ± 13 cm/s (p = 0.02).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only six patients were studied, all male, at a single center, so the results cannot show how common this is in all youth with sports-related brain injury. The report is a small preliminary subset of an ongoing cohort study. Not every patient had serial testing because some were discharged before repeat testing. Middle cerebral artery flow velocity estimates but does not directly measure cerebral blood flow. Only the middle cerebral artery was tested, and the blood pressure drop during tilt testing was not controlled. Formal balance testing was not performed, so dizziness and balance impairment were not linked to autoregulation. No treatment was tested, so the study cannot show that impaired autoregulation causes symptoms or that correcting it improves outcomes.
Declared interests
The supplied text lists NIH extramural and non-U.S. government research support; it does not report author conflicts of interest or industry funding.
The easy way to misread this
Do not conclude that a normal Glasgow Coma Scale means a hospitalized athlete has no brain blood flow regulation problem. In six patients, five had impaired regulation, and all five had Glasgow Coma Scale 15 at testing.