Autonomic Dysfunction After Pediatric Concussion: A Scoping Review

PurposeA concussion is a common injury in children and adolescents. Despite how common these brain injuries are, relatively little is known about the underlying pathophysiology of pediatric concussion. This scoping review aims to collect and synthesize the literature on autonomic dysfunction (AD) in pediatric concussion, with a secondary aim to identify the procedures and measures testing autonomic function (AF).MethodsWe completed a systematic search using six databases of articles pertaining to AD after concussion. The resulting articles were exported, screened, and reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines.ResultsTwenty-two studies met the study criteria and were included in the review. Findings revealed that children and adolescents experience varying degrees of AD after concussion. Fifteen of the 22 studies identified some anomaly related to AD in the concussed pediatric population, though the direction of findings varied across studies and injury phases. The most common autonomic assessment used in studies focused on cardiovascular autonomic reflex testing resulting from orthostatic stressors (n = 10), with other measures including respiratory effects during aerobic exercise and ocular dynamics.ConclusionOverall, there is a gap in our understanding of AD after pediatric concussion. The findings of this study provide mixed results on AD after pediatric concussion. Future research should prioritize prospective studies examining autonomic recovery trajectories across developmental subgroups. Autonomic measures, such as cardioregulatory measures and pupillometry, represent promising emerging markers that require further validation to inform rehabilitation protocols in pediatric concussion.