Assessment of comorbid symptoms in pediatric autonomic dysfunction

Article published in Clinical Autonomic Research by Jeffrey Boris, Sally E. Tarbell, Erin L. Olufs, Philip R. Fischer, Gisela Chelimsky, Mohammed T. Numan, Marvin Medow, Hasan Abdallah, Shelley Ahrens, Ian J. Butler, Thomas C. Chelimsky, Craig Coleby, John E. Fortunato, Raewyn Gavin, Janice Gilden, Renato Gonik, Kelsey Klaas, Lauren Marsillio, Erin Marriott, Laura A. Pace, Paul Pianosi, Pippa Simpson, Julian Stewart, Natalie Van Waning & Debra E. Weese-Mayer

Abstract

Introduction: Data for Emergency Department utilisation and diagnoses in adolescents with postural orthostatic tachycardia syndrome are lacking, making prevention of these visits more difficult to achieve.

Purpose: Pediatric patients with autonomic dysfunction and orthostatic intolerance (OI) often present with co-existing symptoms and signs that might or might not directly relate to the autonomic nervous system. Our objective was to identify validated screening instruments to characterize these comorbidities and their impact on youth functioning.

Methods: The Pediatric Assembly of the American Autonomic Society reviewed the current state of practice for identifying symptom comorbidities in youth with OI. The assembly includes physicians, physician-scientists, scientists, advanced practice providers, psychologists, and a statistician with expertise in pediatric disorders of OI. A total of 26 representatives from the various specialties engaged in iterative meetings to: (1) identify and then develop consensus on the symptoms to be assessed, (2) establish committees to review the literature for screening measures by member expertise, and (3) delineate the specific criteria for systematically evaluating the measures and for making measure recommendations by symptom domains.

Results: We review the measures evaluated and recommend one measure per system/concern so that assessment results from unrelated clinical centers are comparable. We have created a repository to apprise investigators of validated, vetted assessment tools to enhance comparisons across cohorts of youth with autonomic dysfunction and OI.

Conclusion: This effort can facilitate collaboration among clinical settings to advance the science and clinical treatment of these youth. This effort is essential to improving management of these vulnerable patients as well as to comparing research findings from different centers.