Key result
Children with persistent post-concussion symptoms show no increased POTS prevalence versus healthy controls.
Why the study?
Symptoms of persisting post-concussion symptoms (PPCS) significantly overlap with postural orthostatic tachycardia syndrome (POTS), prompting investigation into the prevalence of POTS in children recovering from mild traumatic brain injury.
Does the prevalence of POTS differ between children with persisting post-concussion symptoms following mTBI compared to asymptomatic mTBI patients and healthy controls?
Cross-Sectional (n=113)
No
Does the prevalence of POTS differ between children with persisting post-concussion symptoms following mTBI compared to asymptomatic mTBI patients and healthy controls?
Absolute Event Rate: 4.8% vs 4.2%
POTS is not common or overrepresented in children with persisting post-concussion symptoms following mild traumatic brain injury.
POTS prevalence similar across groups; does not support routine screening and leaves open any association with persisting symptoms.
BACKGROUND: Twenty five percent of children who sustain a mild traumatic brain injury (mTBI) or concussion experience persisting post-concussion symptoms (PPCS). The symptoms of PPCS significantly overlap with postural orthostatic tachycardia syndrome (POTS). We aimed to review the literature and investigate the prevalence of POTS in children and adolescents recovering from mTBI. METHODS: This single centre controlled cross-sectional cohort study recruited children (aged 8-18 years inclusive) diagnosed with mTBI in the emergency department. At 4-6 weeks postinjury, children completed the Active Stand Test. The primary outcome was change in heart rate alongside clinical symptoms consistent with POTS. RESULTS: A total of 113 participants (64 PPCS, 24 mTBI with no clinical symptoms [asymptomatic], and 25 healthy controls) of similar age (mean 13.9 years) and sex (n = 55 [48.7%] male) underwent orthostatic testing. There were no significant group differences in heart rate or blood pressure at baseline, or within 10 minutes of standing. Three (4.8%) symptomatic participants satisfied POTS diagnostic criteria, compared to zero asymptomatic and one (4.2%) control participant. CONCLUSIONS: Using the Active Stand Test, a small proportion of children with PPCS satisfied clinical POTS criteria. Although it should be considered in the differential diagnosis, POTS is not common nor overrepresented in PPCS.
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Stein et al. (2025) conducted a cross-sectional in mild traumatic brain injury (mTBI) with persisting post-concussion symptoms (n=113). Active Stand Test vs. Asymptomatic mTBI patients and healthy controls was evaluated on change in heart rate alongside clinical symptoms consistent with POTS. POTS diagnostic criteria were met by 4.8% of children with persisting post-concussion symptoms, compared to 0% of asymptomatic mTBI patients and 4.2% of healthy controls.
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