Predicting Outcomes in Children with Mild Traumatic Brain Injury

预测轻度创伤性脑损伤儿童的结果

基本信息

批准号：
8557646
负责人：
KEITH O YEATES
金额：
$ 63.92万
依托单位：
RESEARCH INST NATIONWIDE CHILDREN'S HOSP
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-23 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8557646
关键词：
15 year old Accident and Emergency department Acute Adolescent Attention Brain Concussion Caring Child Child Care Childhood Childhood Injury Clinical Cognitive Complex Data Devices Diagnostic Diagnostic Procedure Diffusion Magnetic Resonance Imaging Electronics Emotional Equilibrium Evaluation Face Glasgow Coma Scale Goals Head Health Personnel Home environment Injury Knowledge Lesion Life Magnetic Resonance Imaging Measures Memory Methods Modeling Neurologic Neuropsychological Tests Orthopedics Outcome Pain Participant Pediatric Hospitals Performance Persons Physicians Post-Concussion Syndrome Predictive Value Predisposition Quality of life Recruitment Activity Research Sampling Sensitivity and Specificity Signs and Symptoms Skull Fractures Sports Symptoms Testing Time Traumatic Brain Injury Unconscious State Weight Work Youth balance testing base clinical care clinical practice computerized executive function functional disability improved indexing innovation mental state neuroimaging processing speed prognostic psychologic public health relevance standardize measure tool white matter

项目摘要

DESCRIPTION (provided by applicant): A critical decision confronting health care providers is how to predict in the acute setting which children will suffer persistent postconcussive symptoms (PCS) and functional impairments after mild traumatic brain injury (TBI). Mild TBI occur in >450,000 youth under 15 years of age annually and can result in persistent symptoms associated with significant functional impairments. Various methods are recommended for the diagnostic evaluation of children with mild TBI: assessment of presenting signs/symptoms, acute mental status examination and balance testing, neuropsychological testing, and neuroimaging. However, no previous study has systematically compared the prognostic significance of these methods. The overall goal of the proposed project is to examine the utility of diagnostic methods commonly used in clinical settings in the prediction of persistent PCS and functional impairments. Participants will include 8- to 15-year-old children with mild TBI (n = 200) or mild orthopedic injuries (n = 100), recruited in the Emergency Departments (ED) at two large children's hospitals. Acute signs and symptoms of concussion, as well as mental status and balance, will be assessed using standardized methods at the time of recruitment. All children will complete computerized neuropsychological testing and magnetic resonance imaging (MRI) within 7 days of injury. PCS will be assessed remotely on a weekly basis using electronic devices during the first 6 months post injury. Functional impairments will be assessed in person acutely and 3 and 6 months post injury. Other potential confounds (e.g., children's premorbid functioning; effort; pain; symptom exaggeration) also will be assessed. The proposed research is innovative because no previous study has compared the predictive utility of these commonly-used methods for assessing pediatric mild TBI. Additional innovations include collecting ratings of PCS at home on electronic devices to obtain real-time data from participants; assessing balance using a simple measure commonly employed in sports concussion research but not yet studied in a broad sample of children with mild TBI; using a newly-developed, computerized neuropsychological test battery to assess cognitive abilities; and employing newer MRI sequences capable of detecting subtle abnormalities (i.e., SWI, DTI). Our specific aims are (1) to examine the prediction of PCS and functional impairments following mild TBI and (2) to determine the incremental predictive utility of each of four assessment methods. Statistical analyses will assess the independent and combined contributions of four sets of variables to the prediction of PCS and functional impairments: (a) presenting signs/symptoms; (b) acute mental status and balance testing; (c) neuropsychological testing; and (d) neuroimaging. Prediction will be evaluated using mixed models, as well as traditional indices of clinical utility. A comprehensive study of these diagnostic methods and their incremental utility in predicting outcomes will have a major impact on clinical practice, particularly in acute care settings, by helping improve prognostic determinations, develop decision tools, and focus treatment efforts.

描述（由申请人提供）：卫生保健提供者面临的重要决定是如何在急性环境中预测哪些儿童将遭受轻度创伤性脑损伤（TBI）后持续的脑震荡后症状（PC）和功能障碍。轻度TBI每年在15岁以下的450,000名青年中发生，并可能导致与重大功能障碍有关的持续症状。建议对轻度TBI儿童进行诊断评估的各种方法：评估表征/症状，急性心理状态检查和平衡测试，神经心理学测试和神经影像学。但是，先前没有研究对这些方法的预后意义进行了比较。拟议项目的总体目标是研究在预测持续PC和功能障碍的临床环境中常用的诊断方法的实用性。参与者将包括8至15岁的轻度TBI（n = 200）或轻度骨科伤害（n = 100），在两家大型儿童医院的急诊部门（ED）招募。在招募时，将使用标准化方法评估脑震荡以及心理状况和平衡的急性体征和症状。所有儿童将在受伤后的7天内完成计算机化的神经心理测试和磁共振成像（MRI）。受伤后的头六个月，将使用电子设备每周远程评估PC。功能障碍将急性评估，受伤后3和6个月进行评估。还将评估其他潜在的混杂（例如，儿童的病前功能；努力；疼痛；症状夸大）。拟议的研究具有创新性，因为以前没有研究比较这些常用方法评估小儿轻度TBI的预测效用。其他创新包括在电子设备上收集PC的评级，以从参与者那里获取实时数据；使用在运动脑震荡研究中常见的简单措施来评估平衡，但尚未在一大群轻度TBI的儿童样本中进行研究；使用新开发的计算机化神经心理测试电池来评估认知能力；并采用能够检测出微妙异常的较新的MRI序列（即SWI，DTI）。我们的具体目的是（1）在轻度TBI和（2）下检查PC和功能障碍的预测，以确定四种评估方法中每种方法的增量预测效用。统计分析将评估四组变量对PC和功能障碍的预测的独立和综合贡献：（a）呈现符号/症状；（b）急性心理状况和平衡测试；（c）神经心理学测试；（d）神经影像学。将使用混合模型以及临床实用程序的传统指数评估预测。对这些诊断方法及其在预测结果方面的增量实用性的全面研究将对临床实践，尤其是在急性护理环境中产生重大影响，通过帮助改善预后决定，开发决策工具和重点治疗工作。