Developmental Consequences of Pediatric TBI

描述（由申请人提供）：创伤性脑损伤每年导致17,000名儿童残疾。许多儿童在受伤后没有达到预期的发展轨迹。当已知患有特定发育障碍的儿童有延误的风险时，为他们提供服务;然而，患有创伤性脑损伤的儿童通常无法获得这些服务。 服务该项目的总体目标是了解创伤性脑损伤如何影响儿童的发展。该项目是一项纵向前瞻性队列研究，对象为0至15岁的各种严重程度的创伤性脑损伤儿童。儿童创伤性脑损伤 并从两所参与机构中招募年龄和性别相匹配的骨科损伤儿童作为对照组。具体而言，本项目的目的是首先描述该儿童队列以及年龄和性别匹配的骨科损伤比较儿童的急性、急性后和长期治疗特征。我们将描述儿童的家庭环境以及认知和社会情感储备，因为这些可能会影响儿童短期和长期健康状况的变化。然后，我们将在受伤后的第一年内测量健康特定结果，包括身体健康，脑震荡后症状和压力。我们将使用关键神经心理学领域的生长曲线分析来评估儿童的长期发育进展，包括与骨科损伤儿童相比的认知、社会和心理健康结果。然后，我们将使用结构方程模型来研究损伤的严重程度，家庭环境和神经心理状态对儿童参与日常活动和在学校表现的能力的关系。最后，我们将量化儿童受伤后一年的医疗服务使用和医疗保健费用。本研究的结果将有助于了解创伤前家庭和儿童特征、创伤后儿童缺陷和家庭压力对儿童发展结果的复杂相互作用。这一信息将与儿童目前的保健服务和学校支助服务的使用情况相结合，以便了解服务的障碍，并告知儿童在每个发展阶段所需的支助。

DESCRIPTION (provided by applicant): Traumatic brain injury leaves 17,000 children disabled yearly. Many children do not achieve their expected developmental trajectory after injury. Services exist for children with specific developmental disorders when they are known to be at risk for delays; however, children with traumatic brain injury frequently do not access these services. The overall goal of this project is to understand how traumatic brain injury affects children's development. This project is a longitudinal, prospective cohort study of children 0 to 15 years of age with all severities of traumatic brain injury. Children with traumatic brain injury and a comparison group of age and sex- matched children with orthopedic injury will be recruited from the two participating institutions. Specifically, the aims of this project are to fist characterize this cohort of children and age and sex matched orthopedic injury comparison children in relation to acute, post-acute and longer term treatments. We will characterize the children's family environment and cognitive and socio-emotional reserve as these may influence changes in children's short and longer term health status. Then, we will measure health specific outcomes during the first year after injury, including physical health, post-concussion symptoms, and stress. We will assess children's longer term developmental progress using growth curve analysis of key neuropsychological domains including cognition, social, and psychological health outcomes compared to children with orthopedic injuries. We will then use structural equation modeling to examine the relationships of injury severity, family environment, and neuropsychological status on children's ability to participate in everyday activities and perform i school. Finally, we will quantify children's health service use and health care costs for the year following injury. Results of this research will help to understand the complex interactions of preinjury family and child characteristics, post injury child deficits and family stress on childre's developmental outcomes. This information will be integrated with the children's current health service and school support service use in order to understand the barriers to services and inform the needed supports for children at each developmental stage.