Predicting Psychological Distress after Pediatric Concussion
Predicting Psychological Distress after Pediatric Concussion
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DOI：
10.1089/neu.2018.5792
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发表时间：
2018-10-10
影响因子：
4.2
通讯作者：
Zemek, Roger
中科院分区：
文献类型：
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作者：
Brooks, Brian L.;Plourde, Vickie;Zemek, Roger
相当比例的儿童和青少年报告脑震荡后的心理困扰，但对这些问题的预测因子知之甚少。本研究的目的是探讨儿童脑震荡后心理困扰的预测因素。据推测，损伤前心理困扰的存在将是脑震荡后心理困扰的最强预测因子，其他人口统计学和急性损伤因素逐渐增加预测。这是一项前瞻性、多中心队列研究。儿童和青少年（6-17岁; n=311）谁持续脑震荡，并通过四个儿科急诊科进行评估。参与者在受伤后4周（n=275）和12周（n=190）进行了重新评估。急诊科（艾德）评估记录了损伤机制、急性神经病学、急性认知功能和损伤前功能。如果父母完成的测量（儿童行为检查表，优势和困难问卷）中的一个或多个心理评分超过既定的截止值，则在4周和12周随访时的心理困扰被归类为存在。使用多变量逻辑回归预测每次随访时心理困扰的存在。在脑震荡后4周和12周，23%的年轻人报告了心理困扰。伤前诊断为焦虑和急性遗忘最近的信息是4周时心理困扰的重要预测因素，而艾德中更差的急性定向评估预测了12周时的心理困扰。近四分之一的年轻人在脑震荡后经历了心理痛苦。急性护理环境中的临床医生应筛选与损伤后心理困扰相关的因素（损伤前焦虑，急性精神状态），并考虑主动将患者转诊以获得进一步帮助。
A significant proportion of children and adolescents report psychological distress following concussion, but little is known about the predictors of these problems. The purpose of this study was to examine predictive factors of psychological distress following pediatric concussion. It was hypothesized that the presence of pre-injury psychological distress would be the strongest predictor of psychological distress post-concussion, with other demographic and acute injury factors adding incrementally to prediction. This is a prospective, multi-center cohort. Children and adolescents (6-17 years old; n=311) who sustained a concussion and were assessed through four pediatric emergency departments. Participants were reassessed at 4-weeks (n=275) and 12-weeks (n=190) post-injury. Emergency department (ED) assessment documented injury mechanism, acute symptomatology, acute cognitive functioning, and pre-injury functioning. Psychological distress at 4- and 12-weeks follow-up was categorized as present if one or more psychological scores from the parent-completed measures (Child Behavior Checklist, Strengths and Difficulties Questionnaire) exceeded established cutoffs. The presence of psychological distress at each follow-up was predicted using multi-variable logistic regressions. Psychological distress was reported in 23% of youth at both 4- and 12-weeks post-concussion. A pre-injury diagnosis of anxiety and acutely forgetting recent information were significant predictors of psychological distress at 4 weeks, whereas worse acute orientation assessment in the ED predicted psychological distress at 12 weeks. Nearly one of four youth experienced psychological distress after concussion. Clinicians in acute care settings should screen for the factors (pre-injury anxiety, acute mental status) associated with post-injury psychological distress and consider proactively referring patients for further assistance.