A Risk Stratification Model for Health and Academic Outcomes in Children with Concussion Based on Novel Symptom Trajectory Typologies

基于新症状轨迹类型的脑震荡儿童健康和学业成果的风险分层模型

• 批准号: 10560681
• 负责人: KARIN REUTER-RICE
• 金额: $ 65.63万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10560681
• 关键词: Absenteeism; Adult; Affect; Age; American; Biological; Biological Markers; Brain Concussion; Brain Injuries; Characteristics; Child; Childhood; Clinical; Cognitive; Data; Development; Diagnosis; Early identification; Economic Burden; Emergency department visit; Emotional; Family; Fatigue; Genes; Goals; Growth; Health; Healthcare Systems; Inflammatory; Injury; Intervention; Learning; Link; Measures; Modeling; Neurobehavioral Manifestations; Outcome; Patient Outcomes Assessments; Patient Self-Report; Pattern; Performance; Play; Population Heterogeneity; Post-Concussion Syndrome; Process; Public Health; Quality of life; Reporting; Research; Risk; Schools; Severities; Sex Distribution; Social Behavior; Social Well-Being; Social isolation; Social outcome; Symptoms; Time; Typology; United States National Institutes of Health; Variant; Well in self; Work; acute symptom; care outcomes; clinical care; clinical prognostic; cognitive function; concussive symptom; cost estimate; cytokine; demographics; disparity reduction; emotional symptom; ethnic diversity; evidence base; experience; health care delivery; health disparity; health economics; high risk; improved; improved outcome; insight; meetings; novel; outcome disparities; peer; persistent symptom; personalized care; personalized health care; physical symptom; psychologic; psychological distress; racial diversity; response; risk stratification; social; social factors; societal costs; socioeconomics; symptom management; symptom science

ABSTRACT. Concussions occur at an alarming rate among U.S. schoolchildren, with one in five children experiencing a concussion by age 16. The number of children visiting emergency departments for concussions annually has increased by 50% over the past decade, with an estimated cost to the healthcare system of $1 billion/year. Compared to adults, children experience longer and more severe postconcussive symptoms (PCS). Severity and duration of PCS, however, vary considerably among children, complicating clinical care and return to learn and play. Persistent PCS including physical, emotional, and cognitive symptoms, result in increased school absenteeism, social isolation, and psychological distress. Early PCS diagnosis and access to evidence-based return-to-health and -school interventions are strongly linked to positive health and academic outcomes. Yet models to identify children at high risk for persistent PCS are lacking. PCS have been linked to inflammatory processes occurring within the injured brain. Preliminary evidence suggests that fatigue, another symptom likely contributing to poor outcomes, is also a biological byproduct of pediatric concussions. Importantly, even though 73% of children report continuous fatigue after concussion, this symptom is rarely studied along with other PCS. Prior research has focused on the relationship between inflammatory biomarkers and PCS severity but has not examined this relationship longitudinally. Acute symptom severity alone, however, is a poor prognostic of clinical outcomes in concussed children. Symptom severity immediately postinjury does not explain why at least 25% of children still experience PCS after 1 year or why even children who may appear asymptomatic still report academic and social challenges months after concussion. To identify which children are at high risk for persistent PCS and poor health, academic, and social outcomes, research tracking PCS trajectories and describing school-based impacts across the entire first year postinjury is critically needed. This proposal will 1) define novel PCS trajectory typologies in a racially/ethnically diverse population of 500 children with concussion (11–17 years, near equal distribution by sex), 2) identify associations between these typologies and patterns of inflammatory biomarkers, 3) develop a risk stratification model to identify children at risk for persistent PCS; and 4) gain unique insights and describe PCS impact, including fatigue, on longer-term academic and social outcomes. We will be the first to use NIH's symptom science model and patient-reported outcomes to explore the patterns of fatigue and other physical, cognitive, psychological, emotional and academic responses to concussion in children over a full year. Our model will enable clinicians and educators to identify children most at risk for poor long-term health, social, and academic outcomes after concussion. This work is critical to meeting our long-term goal of developing personalized concussion symptom- management strategies to improve outcomes and reduce disparities in the health and quality of life of children.

摘要。 脑震荡在美国学童中的发生率令人担忧，五分之一的儿童经历过脑震荡。 脑震荡每年因脑震荡前往急诊室就诊的儿童人数 在过去十年中增加了50%，估计医疗保健系统的成本为10亿美元/年。 与成人相比，儿童经历更长和更严重的脑震荡后症状（PCS）。严重程度 然而，PCS的持续时间在儿童中差异很大，使临床护理和恢复学习变得复杂 和玩耍。持续的PCS包括身体，情绪和认知症状，导致学校增加 旷课、社会孤立和心理困扰。PCS的早期诊断和循证医学 恢复健康和重返学校的干预措施与积极的健康和学业成果密切相关。然而 缺乏识别持续性PCS高风险儿童的模式。PCS与炎症有关 在受伤的大脑中发生的过程。初步证据表明，疲劳（另一个症状） 也是小儿脑震荡的生物学副产品。重要的是，即使 虽然73%的儿童报告脑震荡后持续疲劳，但这种症状很少沿着 其他PCS先前的研究集中在炎症生物标志物和PCS严重程度之间的关系 但是没有纵向地研究这种关系。然而，仅急性症状严重程度 脑震荡儿童临床结局的预后。伤后即刻的症状严重程度 解释为什么至少25%的儿童在1年后仍然经历PCS，或者为什么即使是可能出现PCS的儿童， 脑震荡数月后，无症状者仍报告学业和社交挑战。为了确定哪些孩子 持续性PCS的高风险和健康状况差，学术和社会成果，研究跟踪PCS 在整个受伤后的第一年，非常需要轨迹和描述基于学校的影响。这 提案将1）在500名儿童的种族/民族多样化人群中定义新的PCS轨迹类型 脑震荡（11-17岁，按性别分布几乎相等），2）确定这些之间的关联 炎性生物标志物的类型和模式，3）开发风险分层模型，以识别 持续性PCS的风险;以及4）获得独特的见解并描述PCS对长期的影响，包括疲劳 学术和社会成果。我们将是第一个使用NIH的症状科学模型和患者报告的 结果，探讨疲劳和其他身体，认知，心理，情绪和 儿童脑震荡一整年的学术反应。我们的模式将使临床医生和教育工作者 确定脑震荡后最有可能出现长期健康、社会和学业成绩不佳的儿童。 这项工作对于实现我们制定个性化脑震荡症状的长期目标至关重要- 管理战略，以改善儿童健康和生活质量方面的成果并缩小差距。