A longitudinal population-based birth cohort study to understand the past, present, and future of children and youth with traumatic brain injury

项目概要/摘要 在儿童期和青春期期间持续的创伤性脑损伤（TBI）（在此称为“儿科创伤性脑损伤”）。 TBI“）可能导致长期的负面结果。儿童TBI可能会损害这两种技能， 在受伤时发展和技能尚未发展。重要的是， 儿童TBI可能不会立即明显，只有在受伤后数年才出现问题， 这些儿童无法达到发展里程碑。跟踪儿童的纵向数据， TBI进入成年期是罕见的，疾病控制中心也认识到这一局限性， 并在其提交国会的报告中说明。这些数据很重要，因为TBI不是单一的 事件，而是具有影响个体的终身后果的慢性疾病（例如，二次 健康状况）以及整个社会（例如，提高医疗保健水平）。访问和使用 随着青少年向成人护理过渡，医疗保健服务也大大减少， 更糟糕的健康结果和未满足的医疗保健需求。此外，按性别和/或性别分列的数据有限， 尽管有证据表明，性别（生物属性）和性别（社会文化因素） 影响TBI后卫生服务使用和结果。最后，目前儿科TBI的真正负担是 由于大多数关于儿童TBI发生率的数据是基于 在急诊科或医院接受的医疗保健，即使高达90%的儿科 TBI在初级护理、紧急护理和专科护理中得到治疗。这个项目的首要目标是 利用现有的大型数据集，建立一个至少400万人的动态人口出生队列， 加拿大安大略省1992年至2020年12月（预计开始供资）和2020年至2020年12月（预计开始供资） 28年的随访数据。这个出生队列将是美国或加拿大的第一个此类队列 随着更多年份的数据可用，出生队列和随访的样本量 时间也会增加。安大略的所有居民都能从下列机构获得必要的医疗保健服务： 公共资助的卫生系统和收集这些数据是强制性的。因此，这个出生队列 将捕获从出生到随访结束与公共资助的卫生系统的所有互动 时期、迁移或死亡。具体的研究目标是利用这一出生队列：（1）提供 儿童TBI发生率的全面、性别特异性估计;（2）确定儿童TBI发生率的频率 和小儿TBI后发生的继发性健康状况的类型;以及（3）识别 从儿童期到成年期使用儿科TBI后医疗保健。这个早期职业奖将使 PI建立这个出生队列，以生成严格的初步数据，这将增加 成功的R 01应用程序，并扩展她的独立研究计划，以了解长期以来， 儿童TBI后的长期健康结果。

PROJECT SUMMARY/ABSTRACT Traumatic brain injury (TBI) sustained during childhood and adolescence (herein referred to as ‘pediatric TBI’) can result in long-term negative outcomes. Pediatric TBI may compromise both skills that are developing at the time of injury and skills that are yet to develop. Importantly, the consequences of pediatric TBI may not be immediately apparent, with problems only manifesting years post-injury when these children are unable to meet developmental milestones. Longitudinal data that follow children with TBI into adulthood is scarce, a limitation also recognized by the Centers for Disease Control and Prevention and stated in its report to Congress. These data are important because TBI is not a single event but rather, a chronic disease with lifelong consequence affecting individuals (e.g., secondary health conditions) as well as society as a whole (e.g., increased healthcare use). Access to and use of healthcare services is also significantly reduced as adolescents transition to adult care, resulting in worse health outcomes and unmet healthcare needs. In addition, there is limited data by sex and/or gender even though there is evidence that sex (biological attributes) and gender (social-cultural factors) influence health service use and outcomes after TBI. Finally, the true burden of pediatric TBI is currently significantly underestimated because most data on the incidence of pediatric TBI are based on healthcare received in the emergency department or hospital settings even though up to 90% of pediatric TBIs are treated in primary care, urgent care, and specialty care. The overarching goal of this project is to leverage existing large datasets to build a dynamic population-based birth cohort of at least 4 million live births in Ontario, Canada, from 1992 to December 2020 (anticipated start of the funding) and up to 28 years of follow-up data. This birth cohort will be the first of its kind in the United States or Canada and as additional years of data become available, the sample size of the birth cohort and follow-up period will likewise increase. All residents of Ontario receive medically necessary health services from a publicly funded health system and collection of these data are mandatory. As such, this birth cohort will capture all interactions with the publicly funded health system from birth until the end of follow-up period, migration, or death. The specific research objectives are to use this birth cohort to: (1) provide comprehensive, sex-specific estimates of the incidence of pediatric TBI; (2) determine the frequency and types of secondary health conditions that occur post-pediatric TBI; and (3) identify the patterns of healthcare use post-pediatric TBI from childhood to adulthood. This Early Career Award will enable the PI to build this birth cohort to generate rigorous preliminary data that will increase the likelihood of successful R01 applications and extend her independent program of research to understand the long- term health outcomes after pediatric TBI.