A Psychiatric and Imaging Study of Pediatric Mild Traumatic Brain Injury

描述（由申请人提供）：轻度创伤性脑损伤（TBI）是美国的一个主要公共卫生问题。虽然严重创伤性脑损伤的儿童患新的精神疾病的风险很高，但对轻度创伤性脑损伤儿童的研究却受到方法问题的困扰，导致研究结果相互矛盾，并加剧了争议。没有一项关于儿童轻度TBI的精神病学研究不存在与轻度TBI的定义、对照组、结果测量、纵向设计、选择偏差、样本量或损伤和社会心理风险因素评估相关的问题。拟议项目的总体目标是研究轻度创伤性脑损伤儿童新精神疾病发展的伤害和心理社会风险因素。拟议的研究将包括一项为期1年、4次评估的前瞻性纵向研究，对连续治疗的轻度TBI损伤儿童（n=220）和对照组的轻度骨科损伤不涉及大脑的儿童（n=110）。评估将包括经过验证的结构化访谈，以确定精神障碍、适应性行为技能、学术成就、智力功能、家族精神病史和家庭功能。病变识别、病变定位、病变体积、区域体积和白质完整性测量将使用高分辨率结构磁共振成像（MRI）来定义。MRI分析将包括扩散张量成像、敏感性加权成像、t2加权成像和流体衰减反演恢复成像。该研究将检验三个主要假设：(1)与骨科对照相比，轻度创伤性脑损伤的儿童出现新的精神疾病的几率要高得多。(2)儿童变量（损伤前儿童适应功能、损伤前学业和认知功能、损伤前终生精神障碍）和轻度TBI和骨科损伤儿童损伤前家庭变量（社会经济地位、损伤前家庭功能和生活事件、家庭精神病史）可预测儿童新发精神障碍。(3)轻度创伤性脑损伤和骨科损伤儿童损伤后应对策略和损伤后家庭变量（功能和应激源）介导了新发精神障碍的发生。此外，损伤变量（严重程度、脑损伤的存在、弥漫性轴索损伤的程度）将介导轻度TBI和骨科损伤儿童新发精神障碍的发生。本研究将促进更准确的预测，早期识别和改善治疗与轻度创伤性脑损伤相关的儿童精神并发症。

DESCRIPTION (provided by applicant): Mild traumatic brain injury (TBI) is a major public health problem in the United States. While it is well established that children with severe TBI are at high risk for new psychiatric disorder, studies of children with mild TBI are plagued with methodological problems resulting in conflicting findings and fueling controversy. There is not a single psychiatric study of pediatric mild TBI that is free of problems related to definition of mild TBI, control groups, outcome measurements, longitudinal design, selection bias, sample size, or assessment of injury and psychosocial risk factors. The overall goal of the proposed project is to study injury and psychosocial risk factors for the development of new psychiatric disorders in children with mild TBI. The proposed study will involve a 1-year, 4-assessment, prospective longitudinal study of consecutively treated injured children with mild TBI (n=220) and a control group of children with mild orthopedic injuries not involving the brain (n=110). Assessments will include validated structured interviews to identify psychiatric disorders, adaptive behavior skills, academic achievement, intellectual function, family psychiatric history, and family function. Lesion identification, lesion localization, lesion volumetrics, regional volumetrics, and measures of white matter integrity, will be defined using high-resolution structural magnetic resonance imaging (MRI). MRI analyses will include diffusion tensor imaging, susceptibility weighted imaging, T2-weighted imaging, and fluid attenuated inversion recovery imaging. The study will examine three major hypotheses: (1) New psychiatric disorders in children will occur at a significantly higher rate in children with mild TBI compared with orthopedic controls. (2) New-onset psychiatric disorders in children will be predicted by child variables (pre-injury child adaptive function, pre-injury academic and cognitive function, and pre-injury lifetime psychiatric disorders), and pre-injury family variables (socio- economic status, pre-injury family function and life-events, family psychiatric history) in children with mild TBI and orthopedic injury. (3) The occurrence of new-onset psychiatric disorders will be mediated by post-injury child coping strategies and post-injury family variables (functioning and stressors) in children with mild TBI and orthopedic injury. Additionally, injury variables (severity, presence of a brain lesion, extent of diffuse axonal injury) will mediate occurrence of new-onset psychiatric disorders in children with mild TBI and orthopedic injury. This study will foster more accurate prediction, earlier identification and improved treatment of children with psychiatric complications related to mild TBI.