Use of ambulatory blood pressure monitoring in adolescents with SCI: a case series

Spinal Cord Series and Cases, 2017 · DOI: 10.1038/s41394-017-0034-7 · Published: November 3, 2017

Spinal Cord Injury Cardiovascular Science Pediatrics

Simple Explanation

Autonomic cardiovascular regulation is compromised in adult persons with SCI. Repeated symptoms of severe symptomatic hypotension can occur throughout the day, including dizziness, light-headedness, nausea, blurred vision, and syncope. A single seated BP and HR recording is typically collected at each clinical visit; however, given the wide ﬂuctuations in daily BP documented in the adult SCI population, this assessment may not capture the full hemodynamic proﬁle in the adolescent SCI population. In this project, we present three cases of adolescents with SCI who underwent 24-h ABPM to assess hemodynamic changes over the course of a few non-consecutive days.

Study Duration

Not specified

Participants

Three adolescent patients with chronic SCI, ages 14–16

Evidence Level

Case series

Key Findings

1
The ABPM ﬁndings indicate signiﬁcant variation in 24-h cardiovascular hemodynamics among adolescents with SCI.
2
Case 2 and 3 illustrated normal ISAFSCI ﬁnding however after reviewing the ABPM data Case 2 had bouts of diastolic OH and an absent nocturnal dip while Case 3 described a subject that on average was hypotensive 16% of their day with episodic OH 32% of their day.
3
In particular, it is apparent that diastolic OH is prevalent in these three adolescent cases with SCI/D at or above T4.

Research Summary

This case series presents the cardiovascular proﬁle of three adolescent patients with chronic SCI, ages 14–16, following 2 or 3 days of 24-h Ambulatory Blood Pressure Monitoring (ABPM). The ABPM ﬁndings indicate signiﬁcant variation in 24-h cardiovascular hemodynamics among adolescents with SCI. Revision of the ISAFSCI should perhaps give consideration to the likelihood of the recognized cardiovascular abnormalities given the level of injury.

Practical Implications

Improved Assessment

24-h ABPM data on multiple days can lead to an increase awareness of each individual patients’ cardiovascular-autonomic proﬁle.

Clinical Decision Making

Increased awareness of the patient's cardiovascular profile will inform clinical decision making.

Quality of Life

Improved assessment and informed clinical decisions can result in an increase in the patients’ quality of life.

Study Limitations

1
Small sample size (3 cases)
2
The ISAFSCI was created for use in the traumatically injured adult SCI population
3
Lack of normative ABPM data for adolescents with SCI

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