{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:51:15Z","timestamp":1790693475066,"version":"4.1.0"},"reference-count":18,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,5]]},"abstract":"<jats:p>Autonomic nervous system dysfunction (ANSD) is a significant cause of mortality in tetanus. Currently, diagnosis relies on nonspecific clinical signs. Heart rate variability (HRV) may indicate underlying autonomic nervous system activity and represents a potentially valuable noninvasive tool for ANSD diagnosis in tetanus. HRV was measured from three 5-minute electrocardiogram recordings during a 24-hour period in a cohort of patients with severe tetanus, all receiving mechanical ventilation. HRV measurements from all subjects\u2014five with ANSD (Ablett Grade 4) and four patients without ANSD (Ablett Grade 3)\u2014showed HRV was lower than reported ranges for healthy individuals. Comparing different severities of tetanus, raw data for both time and frequency measurements of HRV were reduced in those with ANSD compared with those without. Differences were statistically significant in all except root mean square SD, indicating HRV may be a valuable tool in ANSD diagnosis.<\/jats:p>","DOI":"10.4269\/ajtmh.19-0720","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T02:00:43Z","timestamp":1576202443000},"page":"403-407","source":"Crossref","is-referenced-by-count":38,"title":["Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Tetanus"],"prefix":"10.4269","volume":"102","author":[{"given":"Ha Thi Hai","family":"Duong","sequence":"first","affiliation":[{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girmaw Abebe","family":"Tadesse","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phung Tran Huy","family":"Nhat","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Van","family":"Hao","sequence":"additional","affiliation":[{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"},{"name":"University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Prince","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tran Duc","family":"Duong","sequence":"additional","affiliation":[{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tr\u1ecbnh Trung","family":"Kien","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le Thanh Hoang","family":"Nhat","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le Van","family":"Tan","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Pugh","sequence":"additional","affiliation":[{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huynh Thi","family":"Loan","sequence":"additional","affiliation":[{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Van Vinh","family":"Chau","sequence":"additional","affiliation":[{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lam","family":"Minh Yen","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Zhu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Clifton","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Thwaites","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"},{"name":"Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J Neurol Sci","first-page":"292","article-title":"Case fatality of adult tetanus in Africa: systematic review and meta-analysis","volume":"368","author":"Woldeamanuel","year":"2016"},{"key":"b2","series-title":"Trans R Soc Trop Med Hyg","first-page":"671","article-title":"Impact of improved vaccination programme and intensive care facilities on incidence and outcome of tetanus in southern Vietnam, 1993-2002","volume":"98","author":"Thwaites","year":"2004"},{"key":"b3","series-title":"Lancet","first-page":"1657","article-title":"Tetanus","volume":"393","author":"Yen","year":"2019"},{"key":"b4","series-title":"Anaesthesia","first-page":"355","article-title":"Urinary catecholamine excretion in 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