A longitudinal population-based birth cohort study to understand the past, present, and future of children and youth with traumatic brain injury

项目摘要/摘要 儿童和青春期所遭受的创伤性脑损伤(以下简称儿童脑损伤 )可能会导致长期的负面结果。儿科创伤性脑损伤可能会损害以下两种技能 在受伤时发展和尚未发展的技能。重要的是， 儿童创伤性脑损伤可能不会立即显现，问题只有在受伤后数年才表现出来，当 这些孩子无法达到发展的里程碑。跟踪儿童的纵向数据 进入成年期的脑损伤很少，这一限制也得到了疾病控制和预防中心的承认 预防，并在提交给国会的报告中指出。这些数据很重要，因为TBI不是单一的 事件，而是一种影响个人终生后果的慢性病(例如，继发性 健康状况)以及整个社会(例如，增加医疗保健使用)。获取和使用 随着青少年向成人护理过渡，医疗保健服务也大大减少，导致 更糟糕的健康结果和未得到满足的医疗需求。此外，按性别和/或分类的数据也很有限 性别，尽管有证据表明性别(生物属性)和性别(社会文化因素) 影响颅脑损伤后卫生服务的使用和转归。最后，儿童创伤性脑损伤的真正负担是目前 被大大低估了，因为大多数关于儿童脑外伤发病率的数据都是基于 在急诊科或医院接受的医疗保健，即使高达90%的儿科 颅脑损伤在初级护理、紧急护理和专科护理中接受治疗。这个项目的首要目标是 是利用现有的大型数据集来建立至少400万人的基于人口的动态出生队列 加拿大安大略省1992年至2020年12月的活产儿(预计将开始资助)和 28年的随访数据。这一出生队列将是美国或加拿大的第一个此类队列 随着更多年份的数据可用，出生队列和随访的样本大小 期限也将同样增加。安大略省的所有居民都从安大略省 公共资助的卫生系统和收集这些数据是强制性的。因此，这一出生队列 将记录从出生到后续行动结束期间与公共资助的卫生系统的所有互动 期间、迁徙或死亡。具体的研究目标是利用这一出生队列：(1)提供 全面、按性别估计儿童脑外伤的发病率；(2)确定发生频率 和儿童脑外伤后发生的次级健康状况的类型；以及(3)确定 从儿童到成年，医疗保健使用儿科后创伤性脑损伤。这一早期职业奖将使 PI建立这个出生队列来生成严格的初步数据，这将增加 成功申请R01并扩展她的独立研究计划，以了解长期- 儿童脑外伤后的长期健康结局。

PROJECT SUMMARY/ABSTRACT Traumatic brain injury (TBI) sustained during childhood and adolescence (herein referred to as ‘pediatric TBI’) can result in long-term negative outcomes. Pediatric TBI may compromise both skills that are developing at the time of injury and skills that are yet to develop. Importantly, the consequences of pediatric TBI may not be immediately apparent, with problems only manifesting years post-injury when these children are unable to meet developmental milestones. Longitudinal data that follow children with TBI into adulthood is scarce, a limitation also recognized by the Centers for Disease Control and Prevention and stated in its report to Congress. These data are important because TBI is not a single event but rather, a chronic disease with lifelong consequence affecting individuals (e.g., secondary health conditions) as well as society as a whole (e.g., increased healthcare use). Access to and use of healthcare services is also significantly reduced as adolescents transition to adult care, resulting in worse health outcomes and unmet healthcare needs. In addition, there is limited data by sex and/or gender even though there is evidence that sex (biological attributes) and gender (social-cultural factors) influence health service use and outcomes after TBI. Finally, the true burden of pediatric TBI is currently significantly underestimated because most data on the incidence of pediatric TBI are based on healthcare received in the emergency department or hospital settings even though up to 90% of pediatric TBIs are treated in primary care, urgent care, and specialty care. The overarching goal of this project is to leverage existing large datasets to build a dynamic population-based birth cohort of at least 4 million live births in Ontario, Canada, from 1992 to December 2020 (anticipated start of the funding) and up to 28 years of follow-up data. This birth cohort will be the first of its kind in the United States or Canada and as additional years of data become available, the sample size of the birth cohort and follow-up period will likewise increase. All residents of Ontario receive medically necessary health services from a publicly funded health system and collection of these data are mandatory. As such, this birth cohort will capture all interactions with the publicly funded health system from birth until the end of follow-up period, migration, or death. The specific research objectives are to use this birth cohort to: (1) provide comprehensive, sex-specific estimates of the incidence of pediatric TBI; (2) determine the frequency and types of secondary health conditions that occur post-pediatric TBI; and (3) identify the patterns of healthcare use post-pediatric TBI from childhood to adulthood. This Early Career Award will enable the PI to build this birth cohort to generate rigorous preliminary data that will increase the likelihood of successful R01 applications and extend her independent program of research to understand the long- term health outcomes after pediatric TBI.