Pediatric Mild Head Injury: Definition and Consequences

美国每年有超过100万儿童遭受创伤性脑损伤。大约90%的小儿脑损伤被描述为轻度，但轻度创伤性脑损伤（MTBI）的研究受到分类，测量和概括性问题的困扰。这项前瞻性纵向研究将根据经验支持的标准来定义儿童MTBI，在多种情况下测量认知和心理后遗症，并解释发病前特征对MTBI的贡献。 儿童受伤后出现的症状。将招募50名在急诊科（艾德）接受治疗但未住院的10- 17岁MTBI儿童。MTBI将被定义为头部的钝性创伤或加速减速损伤，随后是短暂意识丧失（<30分钟），短暂的创伤后遗忘症（<24小时），事故发生时精神状态的改变，以及可能是短暂的神经功能缺损。格拉斯哥昏迷量表评分为13-15，任何神经影像学研究均无颅内病理学。 将在急诊室招募50名不涉及头部的严重损伤的对照儿童。将获得相关的历史和人口统计学信息。受伤前的心理，行为和执行功能将通过父母检查表进行评估。神经认知 功能将用已知对脑损伤敏感的仪器来测量。脑震荡后症状（PCS）将通过问卷进行评估。评估将在艾德、一周后和一个月后进行。预计MTBI组在伤后即刻和一周随访时比对照组表现出更多的PCS和神经认知缺陷。考虑到先前的发现，目前尚不清楚MTBI组是否会在伤后4-5周出现更多的PCS和神经认知缺陷。这项研究将有助于儿童MTBI的一致定义，并为进一步调查儿童头部损伤的长期后果奠定基础。

More than 1 million children in the United States sustain traumatic brain injury each year. Approximately 90% of pediatric brain injuries are described as mild, yet mild traumatic brain injury(MTBI) research is plagued by problems of classification, measurement,and generalizability. This prospective, longitudinal study wil lseek to define pediatric MTBI according to empirically supportable criteria, measure cognitive and psychological sequelae on multiple occasions, and account for the contribution of premorbid characteristics to the symptoms experienced by children postinjury. Fifty children ages 10-17with MTBI, treated in the emergency department(ED) but not hospitalized, will be recruited. MTBI will be defined by blunt trauma or acceleration deceleration injury to the head followed by any combination of brief loss of consciousness(<30 min.), brief post-traumatic amnesia (<24 hours),alteration in mental state at the time of the accident, and neurological deficits that may be transient. Glasgow Coma Scale scores will be 13-15 with no intracranial pathology on any neuroimaging studies. Fifty control children with comparably severe injuries not involving the head will be recruited in the ED. Relevant historical and demographic information will be obtained. Pre-injury psychological, behavioral, and executive functioning will be assessed via parent checklists. Neurocognitive functioning wil lbe measured with instruments known to be sensitive to brain injury. Post-concussion symptoms(PCS) wil lbe assessed via a questionnaire.The assessments will occur in the ED, one week later,and one month thereafter.The MTBI group is expected to demonstrate more PCS and neurocognitive deficits than controls immediately post-injury and at the one-week follow-up point.Consideringpriorfindings, it is not clear whether the MTBI group will have more PCS and neurocognitive deficits 4-5 weeks post-injury. This study will contribute to the consistent definition of MTBI in children and set the stage for further investigations of the long-term consequences of head injury in children.