Neurocognitive Evaluation of Mild Traumatic Brain Injury in the Hospitalized Pediatric Population
Neurocognitive Evaluation of Mild Traumatic Brain Injury in the Hospitalized Pediatric Population
复制标题
住院儿童轻度创伤性脑损伤的神经认知评估
作者：
M. Nance;Alison Polk;M. Collins;D. Wiebe
目的：探讨轻型颅脑损伤(MTBI)住院患儿神经认知功能测试的可行性，并对MTBI患儿进行残疾程度评定。背景资料摘要：MTBI在儿科人群中很常见。缺乏一种标准化的方法来识别神经认知损害，并确定恢复体力活动(例如，学校、运动)的最佳时间。方法：在为期两年的时间里，前瞻性地纳入在一级城市儿科创伤中心接受MTBI治疗的儿童(年龄：11-17岁)。在住院期间和出院后的随访诊所中，使用先前验证的基于计算机的测试(脑震荡后即刻评估和认知测试)来评估神经认知能力。评估住院测试的可行性以及神经认知功能障碍和症状的程度。这项研究得到了IRB的批准，并在Clinicaltrials.gov(NCT00715949)注册。结果：在两年的研究中，116名受试者被前瞻性地纳入和测试。人口的平均年龄为14岁，其中69.8%是男性。在最初的住院测试中，总体人群表现出相当大的神经认知缺陷(所有4个分项测试的平均值低于25%，正常值为50%)，95.7%的患者至少有一个分项测试得分低于25%，83.4%的患者出现异常症状评分。在初始测试与后续测试(N=63)比较中，各分测验均有显著改善(言语记忆：28.0%比37.5%，常模50%，P=0.02；视觉记忆：24.9%比38.1%，常模50%，P=0.01；视觉运动：21.8%比31.1%，常模50%，P=0.01；反应时分别为21.8%比30.3%，常模50%，P=0.05)，症状积分下降(分别为26.9比9.2，常模0-8，P<；0.01)。没有在随访中看到的患者(N=53)在人口统计学上与临床上看到的患者没有不同。结论：住院神经认知测试在儿童MTBI患者中是可行的。神经认知异常在最初的评估中几乎是普遍存在的，在门诊随访时显示出显著的改善。因此，对于大多数住院的MTBI儿童，最好推迟恢复活动的建议，直到出院后可以进行正式评估。
Objective:To test the feasibility of inpatient neurocognitive testing and measure the degree of disability in children hospitalized with mild traumatic brain injury (MTBI). Summary Background Data:MTBI is common in the pediatric population. A standardized approach to identify neurocognitive impairment and determine optimal time to return to exertional activities (eg, school, sports) is lacking. Methods:For a 2-year period, children (age: 11–17 years) hospitalized at a level 1 urban Pediatric Trauma Center with MTBI were prospectively enrolled. Neurocognitive performance was assessed utilizing previously validated computer-based tests (Immediate Postconcussion Assessment and Cognitive Testing) as inpatient and in follow-up clinic after discharge. The feasibility of inpatient testing and the degree neurocognitive impairment and symptomatology were assessed. This study was approved by the IRB and registered with clinicaltrials.gov (NCT00715949). Results:For the 2 years of study, 116 subjects were prospectively enrolled and tested. The population had a mean age of 14 years and 69.8% were male. On initial in-hospital testing, the overall population demonstrated considerable neurocognitive deficits (mean values for all 4 subtests below 25th percentile, norm 50%) with at least one subtest score below 25% in 95.7% and an abnormal symptom score in 83.4% of patients. In comparing initial testing to follow-up testing (N = 63), significant improvements were noted for all subtests (verbal memory: 28.0% vs. 37.5%, respectively, norm 50%, P = 0.02; visual memory: 24.9% vs. 38.1%, respectively, norm 50%, P < 0.01; visual motor: 21.8% vs. 31.1%, respectively, norm 50%, P = 0.01; reaction time: 21.8% vs. 30.3%, respectively, norm 50%, P = 0.05), with a decline in the symptom score (26.9 vs. 9.2, respectively, norm 0-8, P < 0.01) as well. Patients not seen in follow-up (N = 53) did not differ demographically from those seen in clinic. Conclusions:Inpatient neurocognitive testing was feasible in pediatric MTBI patients. Neurocognitive abnormalities were nearly universally present on initial evaluation with significant improvements demonstrated at the time of outpatient follow-up. Return to activity recommendations are thus best deferred for most hospitalized MTBI children until formal assessment can be performed after discharge.
脑震荡的神经代谢级联。
影响因子：
3.3
作者：
Giza,ChristopherC.;Hovda,DavidA.
通讯作者：
Hovda,DavidA.