A Psychiatric and Imaging Study of Pediatric Mild Traumatic Brain Injury

描述(申请人提供)：轻度创伤性脑损伤(TBI)在美国是一个主要的公共卫生问题。虽然众所周知，患有严重脑外伤的儿童患新的精神障碍的风险很高，但对患有轻度脑外伤的儿童的研究受到方法学问题的困扰，导致相互矛盾的结果和引发争议。没有一项儿科轻度脑损伤的精神病学研究不存在与轻度脑损伤的定义、对照组、结果测量、纵向设计、选择偏差、样本量或损伤和心理社会危险因素评估有关的问题。拟议项目的总体目标是研究轻微脑外伤儿童发生新的精神障碍的伤害和心理社会风险因素。这项拟议的研究将包括一项为期一年、4次评估的前瞻性纵向研究，研究对象为220名接受连续治疗的轻度脑损伤儿童，以及110名未涉及大脑的轻度骨科损伤儿童的对照组。评估将包括经过验证的结构化访谈，以确定精神障碍、适应行为技能、学业成就、智力功能、家庭精神病史和家庭功能。将使用高分辨率结构磁共振成像(MRI)定义病变识别、病变定位、病变体积测量、区域体积测量和脑白质完整性测量。MRI分析将包括扩散张量成像、磁化率加权成像、T2加权成像和液体衰减反转恢复成像。这项研究将检验三个主要假设：(1)与矫形外科对照组相比，轻度脑外伤儿童中新的精神障碍的发生率明显更高。(2)轻度颅脑损伤和骨科损伤儿童的儿童变量(伤前儿童适应功能、伤前学习和认知功能、伤前终生精神障碍)和伤前家庭变量(社会经济状况、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)轻度颅脑损伤和骨科损伤儿童的新发精神障碍的发生将受到儿童创伤后应对策略和伤害后家庭变量(功能和应激源)的调节。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)将调节轻度颅脑损伤和骨科损伤儿童新发精神障碍的发生。这项研究将促进更准确的预测、更早的识别和改善与轻度脑外伤相关的精神并发症的治疗。

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.