Outcomes of Traumatic Brain Injury in Children

申请人正在寻求K 02（独立科学家奖），以继续建立一个专注于儿童创伤性脑损伤（TBI）结果的研究计划。他的目标是（1）调查儿童TBI后的发展如何与损伤的严重程度，受伤时的年龄和受伤后的时间有关;（2）检查环境因素作为TBI恢复的调节因素的作用;（3）研究脑局灶性病变，认知和社会问题解决技能，以及TBI后“真实的世界”社会功能之间的关系。他一直是一项关于学龄儿童中度至重度TBI的前瞻性纵向研究的共同研究者，目前是NICHD资助的研究补助金的主要研究者，以研究儿童和青少年轻度闭合性头部损伤（CHI）的结果（见下文）。他未来的研究工作将包括学龄前儿童TBI的研究和TBI对儿童社会发展的影响。他提出的职业发展计划将提高他在与其研究有关的统计方法方面的技能，包括（a）纵向数据分析，（B）缺失数据处理，以及（c）稳健的统计方法。他还将获得负责任的研究行为的额外培训。本研究的具体目的是检查轻度CHI儿童脑震荡后症状的（1）自然史，（2）预测和（3）后果。本研究将在同期队列/前瞻性研究设计中纳入200例8 - 15岁轻度CHI儿童和100例不涉及头部的轻度骨科损伤儿童。在受伤后的第一年内，对儿童及其家人进行四次评估（即，在损伤后1周、1个月、3个月和12个月）。脑震荡后的症状进行了评估，使用评级量表和访谈，与儿童和父母作为线人。脑震荡后症状的预测因素包括损伤特征、认知能力、非损伤相关的儿童和家庭变量。结果包括学校的表现，健康利用，以及儿童和家庭功能的其他方面。本研究将检验三个主要假设：（1）轻度CHI的儿童比轻度骨科损伤的儿童表现出更多的脑震荡后症状。(2)脑震荡后症状的发生率与（a）损伤特征，（B）认知技能损伤，和（c）非损伤相关的儿童和家庭因素有关。(3)严重的脑震荡后症状与更多的儿童残疾有关。这些发现将有助于解决与轻度CHI相关的结果的科学争议，并将帮助医生和其他医疗保健提供者识别和管理轻度CHI的后遗症。

DESCRIPTION (provided by applicant): The applicant is seeking a K02 (Independent Scientist Award) to continue building a program of research focusing on the outcomes of childhood traumatic brain injury (TBI). His objectives are (1) to investigate how children's development following TBI is related to severity of injury, age at injury, and time since injury; (2) to examine the role of environmental factors as moderators of recovery from TBI; and (3) to study the relationships between focal brain lesions, cognitive and social problem-solving skills, and "real world" social functioning following TBI. He has been a Co-Investigator on a prospective, longitudinal study of moderate to severe TBI in school-age children, and currently is Principal Investigator on an NICHD-funded research grant to study the outcomes of mild closed head injuries (CHI) in children and adolescents (see below). His future research efforts will include studies of TBI in preschool children and of the effects of TBI on children's social development. His proposed career development plan will enhance his skills in statistical methods pertinent to his research, including (a) analysis of longitudinal data, (b) treatment of missing data, and (c) robust statistical methods. He also will obtain additional training in the responsible conduct of research. The specific aims of the research are to examine the (1) natural history, (2) prediction, and (3) consequences of post-concussive symptoms in children with mild CHI. The study will involve 200 8 to 15 year old children with mild CHI and 100 with mild orthopedic injuries not involving the head in a concurrent cohort/prospective research design. The children and their families are assessed four times during the first year post injury (i.e., at 1 week, 1 month, 3 months, and 12 months post-injury). Post-concussive symptoms are assessed using rating scales and interviews, with both children and parents as informants. Predictors of post-concussive symptoms include injury characteristics, cognitive abilities, and non-injury related child and family variables. Outcomes include school performance, health utilization, and other aspects of child and family functioning. The study will examine three major hypotheses: (1) Children with mild CHI display more post-concussive symptoms than children with mild orthopedic injuries. (2) The incidence of post-concussive symptoms is related to (a) injury characteristics, (b) impairments in cognitive skills, and (c) non-injury related child and family factors. (3) Severe post-concussive symptoms are associated with more child disability. The findings will help resolve the scientific controversy regarding the outcomes associated with mild CHI, and will assist physicians and other health care providers in identifying and managing the sequelae of mild CHI.