Effect of treatment on outcome after TBI in children and adolescents

描述（由申请人提供）：过去二十年的研究描述了儿童和青少年TBI的流行病学，概述了恢复的自然历史，并确定了损伤后的功能结果。关于急性、短期和长期治疗阶段对脑外伤后功能、社会心理和残疾结局的影响，仍然存在重要的问题。在这个项目中，Harborview医疗中心、德克萨斯儿童医院、全国儿童医院和费城儿童医院提出了一项针对7-18岁个体发生的复杂的轻度、中度和重度TBI的多中心研究，以实现这些目标：目标1。从年龄、病因、损伤类型、伴随体征和症状、内科和外科合并症的类型和严重程度、先前存在的疾病、急性护理医院入院和出院时的功能状态等方面描述复杂的轻度、中度和重度TBI；并研究损伤后6、12、24和36个月TBI的特定特征与教育、职业、行为和社会结果之间的关系。目标2。确定TBI初次住院期间、住院和门诊康复治疗期间接受的治疗，以及治疗与人口统计学和损伤因素的关系。目标3。确定在急性住院和康复阶段接受的治疗与受伤后6、12、24和36个月的教育、职业、行为和社会功能结果的关系，包括与不同发育阶段的教育和职业里程碑的实现的关系。这项研究将解决许多关于儿童创伤性脑损伤尚未解决的问题。它在很多方面都是创新的。这是一项多中心研究，汇集了美国儿科TBI的领先专业知识。它将采用新制定的共同数据要素来确定伤害的特征，并采用新制定的护理质量指标来确定住院康复护理的特征。该研究将利用新的PROMIS结果测量，并使用基于网络的技术从护理人员和患者中以纵向方式收集数据。通过应用新颖的统计方法来评估观察性设计中的因果效应，它将提供关于不同阶段的cae治疗对TBI后功能结局的影响的关键信息。研究小组是一个独特的跨学科小组，由经验丰富的研究人员组成，他们有能力开展严谨的研究，为未来的研究、护理和政策提供信息。

DESCRIPTION (provided by applicant): Studies over the last two decades have described the epidemiology of TBI in children and adolescents, outlined the natural history of recovery, and determined the functional outcome following injury. Important questions remain about the effect of treatment during the acute, short-term, and longer-term phases of care on the functional, psychosocial, and disability outcomes after TBI. In this project, Harborview Medical Center, Texas Children's Hospital, Nationwide Children's Hospital, and the Children's Hospital of Philadelphia propose a multicenter study of complicated mild, moderate, and severe TBI occurring to individual's ages 7-18 years to address these aims: Aim 1. Characterize complicated mild, moderate and severe TBI with respect to age, cause, type of injury, accompanying signs and symptoms, type and severity of medical and surgical co-morbidities, and pre-existing conditions, functional status at admission and discharge from the acute care hospital; and examine the association between specific characteristics of TBI and educational, vocational, behavioral, and social outcomes 6, 12, 24 and 36 months after injury. Aim 2. Determine the treatment received during the initial hospitalization for TBI, and during inpatient and outpatient rehabilitation and therapy, and the relationship of treatment to demographic and injury factors. Aim 3. Determine the association of treatment received during the acute inpatient and rehabilitation phases of care with the educational, vocational, behavioral, and social functional outcomes 6, 12, 24 and 36 months after injury, including the association with attainment of educational and vocation milestones at different developmental stages. This study will address many of the unanswered questions on pediatric TBI. It is innovative in many ways. It is a multi-centered study bringing together leading expertise in the United States on pediatric TBI. It will employ the newly developed Common Data Elements for characterizing injuries and the newly developed quality of care indicators for characterizing their inpatient rehabilitation care. The study will utilize the new PROMIS outcome measures and collect data in a longitudinal fashion from both caregivers and patients using web- based technology. By applying novel statistical approaches designed to assess causal effects in observational designs, it will provide critical information on the effects of treatment at different stages of cae on functional outcomes after TBI. The study team represents a uniquely interdisciplinary group of very experienced investigators who are capable of carrying out a rigorous study to provide information to inform future research, care and policy. PUBLIC HEALTH RELEVANCE: Project Narrative This study will address many of these unanswered questions surrounding pediatric traumatic brain injury (TBI), including determining the effect of treatment during the acute, short-term, and longer-term phases of care on the functional, psychosocial, and disability outcomes after TBI occurring to children and adolescents. It will study TBI of different severity and follow children over the 3 years after injury.