Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive study

Background: Clinical presentation varies in children with Orthostatic Intolerance. This study aimed to evaluate the epidemiological and clinical characteristics of pediatric patients with orthostatic intolerance (OI) and positive head-up tilt test (HUTT). Methods: This study was a retrospective revi...

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Main Authors: Anand Gourishankar, Mathew D. Belton, S. Shahrukh Hashmi, Ian J. Butler, Jeremy E. Lankford, Mohammed T. Numan
Format: Article
Language:English
Published: Elsevier 2020-02-01
Series:Pediatrics and Neonatology
Online Access:http://www.sciencedirect.com/science/article/pii/S1875957218307137
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spelling doaj-5cfffdf9493947f89c5094c6075453182020-11-25T02:26:12ZengElsevierPediatrics and Neonatology1875-95722020-02-016116874Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive studyAnand Gourishankar0Mathew D. Belton1S. Shahrukh Hashmi2Ian J. Butler3Jeremy E. Lankford4Mohammed T. Numan5Division of Pediatric Hospital Medicine, Department of Pediatrics, The University of Texas Health Science Center, McGovern Medical School at Houston, TX USA; Corresponding author. Pediatric Hospital Medicine, Pediatrics, 6431 Fannin, Houston, TX 77030-1503 USA. Tel.: +(713) 500 5586. Fax: +713 4860838.Division of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas Health Science Center, McGovern Medical School at Houston, TX USAPediatric Research Center, Department of Pediatrics, The University of Texas Health Science Center, McGovern Medical School at Houston, TX USADivision of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas Health Science Center, McGovern Medical School at Houston, TX USADivision of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas Health Science Center, McGovern Medical School at Houston, TX USADivision of Pediatric Cardiology, Department of Pediatrics, The University of Texas Health Science Center, McGovern Medical School at Houston, TX USABackground: Clinical presentation varies in children with Orthostatic Intolerance. This study aimed to evaluate the epidemiological and clinical characteristics of pediatric patients with orthostatic intolerance (OI) and positive head-up tilt test (HUTT). Methods: This study was a retrospective review of clinical data from outpatients over 18 months period. Results: We included 112 patients with abnormal HUTT results. Females were 78 (70%). Mean age of presentation was 15.6 years (sd: 3.3). Fifteen percent were overweight, and 14% were obese. A headache and syncope were the most frequent presenting symptoms (46% and 29% respectively). Review of systems identified more patients with headaches (84%), Syncope (61%), presyncope (87%) and abdominal pain (29%). Except for fatigue being more prevalent during a review of systems among patients with severe OI (69%) compared to those with moderate OI (46%, p = 0.02), there was no statistically significant difference in the clinical presentation between investigator-defined moderate and severe OI. Comorbidities identified in this cohort were Chiari malformations (9%), idiopathic intracranial hypertension (9%), electroencephalographic abnormalities (8%) and patent foramen ovale (43%). Conclusions: Adolescents, mainly females had OI. Patients with OI and abnormal HUTT predominantly had a headache, syncope, and presyncope during the presentation. Eliciting review of systems and using tools such as clinical questionnaire identifies significant clinical presenting features and comorbidities. Key Words: orthostatic intolerance, tilt-table test, dysautonomia, syncope, autonomic dysfunctionhttp://www.sciencedirect.com/science/article/pii/S1875957218307137
collection DOAJ
language English
format Article
sources DOAJ
author Anand Gourishankar
Mathew D. Belton
S. Shahrukh Hashmi
Ian J. Butler
Jeremy E. Lankford
Mohammed T. Numan
spellingShingle Anand Gourishankar
Mathew D. Belton
S. Shahrukh Hashmi
Ian J. Butler
Jeremy E. Lankford
Mohammed T. Numan
Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive study
Pediatrics and Neonatology
author_facet Anand Gourishankar
Mathew D. Belton
S. Shahrukh Hashmi
Ian J. Butler
Jeremy E. Lankford
Mohammed T. Numan
author_sort Anand Gourishankar
title Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive study
title_short Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive study
title_full Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive study
title_fullStr Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive study
title_full_unstemmed Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive study
title_sort demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; a retrospective descriptive study
publisher Elsevier
series Pediatrics and Neonatology
issn 1875-9572
publishDate 2020-02-01
description Background: Clinical presentation varies in children with Orthostatic Intolerance. This study aimed to evaluate the epidemiological and clinical characteristics of pediatric patients with orthostatic intolerance (OI) and positive head-up tilt test (HUTT). Methods: This study was a retrospective review of clinical data from outpatients over 18 months period. Results: We included 112 patients with abnormal HUTT results. Females were 78 (70%). Mean age of presentation was 15.6 years (sd: 3.3). Fifteen percent were overweight, and 14% were obese. A headache and syncope were the most frequent presenting symptoms (46% and 29% respectively). Review of systems identified more patients with headaches (84%), Syncope (61%), presyncope (87%) and abdominal pain (29%). Except for fatigue being more prevalent during a review of systems among patients with severe OI (69%) compared to those with moderate OI (46%, p = 0.02), there was no statistically significant difference in the clinical presentation between investigator-defined moderate and severe OI. Comorbidities identified in this cohort were Chiari malformations (9%), idiopathic intracranial hypertension (9%), electroencephalographic abnormalities (8%) and patent foramen ovale (43%). Conclusions: Adolescents, mainly females had OI. Patients with OI and abnormal HUTT predominantly had a headache, syncope, and presyncope during the presentation. Eliciting review of systems and using tools such as clinical questionnaire identifies significant clinical presenting features and comorbidities. Key Words: orthostatic intolerance, tilt-table test, dysautonomia, syncope, autonomic dysfunction
url http://www.sciencedirect.com/science/article/pii/S1875957218307137
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