Statistical methods to support a model pediatric traumatic brain injury data bank

描述(由申请人提供)：尽管每年有超过150万美国儿童因头部损伤来急诊室就诊，但儿童创伤性脑损伤(TBI)的许多方面仍未得到很好的了解。研究人员在更好地理解脑外伤方面取得了长足的进步，以帮助完成NICHD的使命，以确保“……所有儿童都有机会充分发挥他们的潜力，过上健康和多产的生活，不受疾病或残疾的影响，并通过最佳康复确保所有人的健康、生产力、独立性和福祉。”对于儿科脑外伤来说，这项研究尤其具有挑战性，而且成本高昂。因此，大多数研究规模都很小，关于不同人群差异的信息有限。只有将几项研究放在一起分析，才能发现损伤和人口统计的广泛范围内的症状差异。已经有一些统计方法的发展，用于联合分析小的纵向数据集合。这项工作为解决这一问题建立了一个总体框架，但并没有填充如何处理现实世界数据复杂性的细节。这项建议的总体目标是通过一个不同年龄的创伤后脑损伤恢复的案例研究，确定联合分析儿童脑损伤类似研究的可行性和益处。该项目的具体目标是：1.使用现有的荟萃分析方法来研究年龄在以下方面的影响 使用两个完整的观察性研究数据集，同时准确地识别当前的方法限制，研究人员可以利用这两个完整的观察性研究数据集，对脑损伤的短期和长期症状进行评估。2.在已建立的元分析和缺失数据方法的基础上开发新的统计方法，以联合分析来自观察性研究的儿科脑损伤数据集。3.确定创建俄亥俄州儿科TBI数据库的后续步骤。OPT数据库将是一个数据仓库，用于研究源自俄亥俄州三家主要儿童医院之一的儿科脑损伤。这将有助于通过对一个更大的 数据集，并将作为在广泛的类似领域中共享数据的模式。这些目标的实现将为更好地了解脑外伤对儿科人群的影响铺平道路。反过来，这将改善对这些儿童和青少年的治疗。其次，新开发的统计方法将适用于广泛的类似医疗领域，从而显著改善以患者为中心的合理决策的证据基础。

DESCRIPTION (provided by applicant): While annually over 1/2 million American children visit the emergency room with a head injury, many aspects of pediatric traumatic brain injury (TBI) are still not well understood. Researchers have been making great strides toward a better understanding of TBI to help fulfill the mission of the NICHD to ensure "...that all children have the chance to achieve their full potential for healthy and productive lives, free from disease or disability, and to ensure the health, productivity, independence, and well-being of all people through optimal rehabilitation." For pediatric TBI, this research is particularly challenging and costly to conduct. Thus, most studies are small with limited information about differences across populations. Only analyzing several studies together would permit the discovery of symptom differences across broad spectra of injuries and demographics. There has already been some development of statistical methods for jointly analyzing small collections of longitudinal data. This work has established a general framework for approaching this problem, but has not filled in the details of how to deal with real-world data complications. The broad goal of this proposal is to establish the feasibility and benefit of jointly analyzing similar studies of pediatric TBI through a case study of the variation in TBI recovery across age at injury. The specific aims of the project are to: 1. Use currently available meta-analytic methods to study the effect of age at injury on short- and long- term symptoms of TBI using two completed observational study datasets, while simultaneously precisely identifying current methodological limitations. 2. Develop new statistical methods based on established meta-analytic and missing data approaches to jointly analyze pediatric TBI datasets from observational studies. 3. Identify next steps for creating the Ohio Pediatric TBI Data Bank. The OPT Data Bank would be a data warehouse for studies of pediatric TBI originating at one of the three major Ohio children's hospitals. It would facilitate improved studies of pediatric TBI via the joint analysis of a larger data set, and would serve as a model for data sharing in a wide range of similar fields. The achievement of these aims will pave the way for improved understanding of the effects of TBI in the pediatric population. In turn, this will lead to improved treatment of these children and adolescents. Second, the newly developed statistical methods will be applicable to a broad range of similar medical areas, thus significantly improving the evidence base for making sound patient-centered decisions.