Pediatric Mild Head Injury: Definition and Consequences

美国每年有100多万儿童遭受创伤性脑损伤。大约90%的儿童脑损伤被描述为轻度，但轻度创伤性脑损伤(MTBI)的研究受到分类、测量和概括性问题的困扰。这项前瞻性的纵向研究将寻求根据经验支持的标准来定义儿科MTBI，在多个情况下测量认知和心理后遗症，并说明发病前特征对儿童MTBI的影响。 儿童受伤后所经历的症状。将招募50名10-17岁患有MTBI的儿童，他们在急诊科接受治疗，但不住院。MTBI的定义是头部的钝性创伤或加速减速损伤，然后是短暂的意识丧失(&lt；30分钟)、短暂的创伤后失忆(&lt；24小时)、事故发生时精神状态的改变，以及可能是一过性的神经功能障碍。格拉斯哥昏迷评分将在13-15分之间，在任何神经成像研究中都没有颅内病变。教育署会招募50名受伤程度相若但不涉及头部的对照儿童。将获得相关的历史和人口信息。受伤前的心理、行为和执行功能将通过父母检查表进行评估。神经认知 将使用已知对脑损伤敏感的仪器来测量功能。脑震荡后症状(PCS)将通过问卷调查进行评估。评估将在伤后一周和一个月后在ED进行。MTBI组在伤后即刻和一周随访点显示出比对照组更多的PCS和神经认知障碍。从先前的研究结果来看，MTBI组在伤后4-5周是否会有更多的PCS和神经认知障碍尚不清楚。这项研究将有助于统一儿童MTBI的定义，并为进一步研究儿童头部损伤的长期后果奠定基础。

More than 1 million children in the United States sustain traumatic brain injury each year. Approximately 90% of pediatric brain injuries are described as mild, yet mild traumatic brain injury(MTBI) research is plagued by problems of classification, measurement,and generalizability. This prospective, longitudinal study wil lseek to define pediatric MTBI according to empirically supportable criteria, measure cognitive and psychological sequelae on multiple occasions, and account for the contribution of premorbid characteristics to the symptoms experienced by children postinjury. Fifty children ages 10-17with MTBI, treated in the emergency department(ED) but not hospitalized, will be recruited. MTBI will be defined by blunt trauma or acceleration deceleration injury to the head followed by any combination of brief loss of consciousness(<30 min.), brief post-traumatic amnesia (<24 hours),alteration in mental state at the time of the accident, and neurological deficits that may be transient. Glasgow Coma Scale scores will be 13-15 with no intracranial pathology on any neuroimaging studies. Fifty control children with comparably severe injuries not involving the head will be recruited in the ED. Relevant historical and demographic information will be obtained. Pre-injury psychological, behavioral, and executive functioning will be assessed via parent checklists. Neurocognitive functioning wil lbe measured with instruments known to be sensitive to brain injury. Post-concussion symptoms(PCS) wil lbe assessed via a questionnaire.The assessments will occur in the ED, one week later,and one month thereafter.The MTBI group is expected to demonstrate more PCS and neurocognitive deficits than controls immediately post-injury and at the one-week follow-up point.Consideringpriorfindings, it is not clear whether the MTBI group will have more PCS and neurocognitive deficits 4-5 weeks post-injury. This study will contribute to the consistent definition of MTBI in children and set the stage for further investigations of the long-term consequences of head injury in children.