Association Between an Autonomic Symptom Cluster Profile Score and Exercise Intolerance in Pediatric Concussion Patients

Background: Autonomic symptom profile scoring offers a quantifiable measure of autonomic nervous system dysfunction and may serve as a useful marker to stratify patients at higher risk for exercise intolerance (EI). Understanding the relationship between these scores and exercise tolerance (ET) could improve individualized treatment planning in pediatric concussion care. Hypothesis: Higher autonomic profile scores are associated with a greater incidence of exercise intolerance in pediatric patients recovering from concussion. Methods: A retrospective analysis was conducted on 50 pediatric concussion patients over 140 clinical encounters, comparing autonomic profile scores between those with and without exercise intolerance. The autonomic profile score was based on 3 screening questions regarding excessive sweating, abnormal HR response, and positional symptoms. Exercise tolerance was determined by a concussion specialist based on the onset of signs/symptoms, significant worsening during pre- and post-exertion visual or vestibular testing, and/or evidence of cardiovagal dysautonomia indicated by post-exertional orthostatics. Statistical analysis included Pearson correlation to assess the strength and direction of the relationship between autonomic CP scores and EI. Mann-Whitney U test was completed for group comparisons between EI and ET groups and Cohen’s d to evaluate effect size. Mean differences were also calculated to enhance interpretability. Results: There was a statistically significant moderate positive correlation between autonomic clinical profile scores and exercise intolerance (r = 0.29, p = 0.000514). Additionally, patients with exercise intolerance (mean = 0.51) had significantly higher scores than those with exercise tolerance (mean = 0.21; p = 0.000514). The effect size was moderate to large (Cohen’s d = 0.60), indicating a meaningful difference between the groups. Conclusion: These findings support a moderate association between autonomic dysfunction, as measured by an autonomic symptom cluster profile score, and the incidence of exhibited exercise intolerance in pediatric concussion patients. The significant difference in scores and meaningful effect size underscore the potential utility of incorporating an autonomic profile score into standard concussion assessments. This approach may help identify patients at greater risk for EI and autonomic dysregulation, allowing for more individualized and targeted treatment. Ongoing research is needed to clarify the association between autonomic profile scores and exercise tolerance and to explore its potential clinical implications.