A Psychiatric and Imaging Study of Pediatric Mild Traumatic Brain Injury

儿科轻度创伤性脑损伤的精神病学和影像学研究

• 批准号: 8193942
• 负责人: JEFFREY Edwin MAX
• 金额: $ 56.34万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8193942
• 关键词: Academic achievement; Accidents; Acute; Adaptive Behaviors; Attenuated; Behavioral; Behavioral Symptoms; Benign; Birth; Brain; Child; Child Behavior; Childhood; Clinical; Cognitive; Conflict (Psychology); Control Groups; Development; Diagnosis; Diagnostic; Diffuse Axonal Injury; Diffusion Magnetic Resonance Imaging; Disease; Early identification; Event; Family; Fostering; Goals; Image; Image Analysis; Injury; Interview; Investigation; Lesion; Life; Liquid substance; Longitudinal Studies; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Medical; Mental disorders; Methods; Modeling; Orthopedics; Outcome; Outcome Measure; Outcome Study; Parents; Plague; Population Study; Post-Concussion Syndrome; Predisposing Factor; Predisposition; Prospective Studies; Public Health; Questionnaires; Recording of previous events; Recovery; Relative (related person); Reporting; Research; Research Design; Resolution; Risk; Risk Factors; Sample Size; Selection Bias; Severities; Socioeconomic Status; Source; Structure; Time; Trauma; Traumatic Brain Injury; United States; Weight; Writing; aged; cognitive function; computerized; coping; design; executive function; high risk; improved; indexing; injured; longitudinal design; meetings; prospective; psychologic; psychosocial; skills; stressor; teacher; white matter; Academic achievement; Accidents; Acute; Adaptive Behaviors; Attenuated; Behavioral; Behavioral Symptoms; Benign; Birth; Brain; Child; Child Behavior; Childhood; Clinical; Cognitive; Conflict (Psychology); Control Groups; Development; Diagnosis; Diagnostic; Diffuse Axonal Injury; Diffusion Magnetic Resonance Imaging; Disease; Early identification; Event; Family; Fostering; Goals; Image; Image Analysis; Injury; Interview; Investigation; Lesion; Life; Liquid substance; Longitudinal Studies; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Medical; Mental disorders; Methods; Modeling; Orthopedics; Outcome; Outcome Measure; Outcome Study; Parents; Plague; Population Study; Post-Concussion Syndrome; Predisposing Factor; Predisposition; Prospective Studies; Public Health; Questionnaires; Recording of previous events; Recovery; Relative (related person); Reporting; Research; Research Design; Resolution; Risk; Risk Factors; Sample Size; Selection Bias; Severities; Socioeconomic Status; Source; Structure; Time; Trauma; Traumatic Brain Injury; United States; Weight; Writing; aged; cognitive function; computerized; coping; design; executive function; high risk; improved; indexing; injured; longitudinal design; meetings; prospective; psychologic; psychosocial; skills; stressor; teacher; white matter

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. PUBLIC HEALTH RELEVANCE: Narrative Pediatric mild traumatic brain injury (TBI) is a major public health problem in the United States. This study will assess predictors and mechanisms for the development of new-onset psychiatric disorders in children after mild TBI and orthopedic injury by examining child, family, and injury risk factors. This study will foster more accurate prediction, earlier identification and improved treatment of children with psychiatric complications related to mild TBI.

描述（由申请人提供）：轻度创伤性脑损伤（TBI）是美国的主要公共卫生问题。虽然众所周知，患有严重TBI的儿童患有新的精神疾病的高风险，但对轻度TBI的儿童的研究困扰着方法论问题，导致发现矛盾，并加剧了争议。小儿轻度TBI没有一项精神病研究，该研究没有与轻度TBI，对照组，结果测量，纵向设计，选择偏见，样本量或评估伤害和心理社会风险因素的定义有关的问题。拟议项目的总体目标是研究轻度TBI儿童新精神疾病的伤害和社会心理危险因素。拟议的研究将涉及一项为期1年的4次评估，前瞻性纵向研究，该研究是针对轻度TBI的受伤儿童（n = 220）和一组无涉及大脑的轻度骨科损伤儿童的对照组（n = 110）。评估将包括经过验证的结构化访谈，以识别精神疾病，适应性行为技能，学术成就，智力功能，家庭精神病史和家庭功能。病变鉴定，病变定位，病变体积，区域体积以及白质完整性的度量，将使用高分辨率的结构磁共振成像（MRI）定义。 MRI分析将包括扩散张量成像，敏感性加权成像，T2加权成像和流体衰减的反转恢复成像。 该研究将研究三个主要假设：（1）与骨科对照相比，轻度TBI儿童的儿童新精神疾病的发生率明显更高。 （2）儿童的新发作的精神疾病将由儿童变量（受害前的儿童适应性功能，受害前的学术和认知功能以及受伤前的终身精神疾病），以及受伤前的家庭变量（社会经济状况（社会经济状况，损害，受害者的家庭功能和生活expecters tery-Eckents tery-Isssical，sedical and Iblusiti and Childe and Childe and Childiti and Childer and Childer and Childer and Childer and Childer and Childer and Childer and Childer and Childe and Childer and Childe and Childer）and and Childer和儿童。 （3）新发作的精神疾病的发生将是通过轻度TBI和骨科损伤儿童的伤害后儿童应对策略和伤害后家庭变量（功能和压力源）介导的。另外，损伤变量（严重程度，脑部病变的存在，弥漫性轴突损伤程度）将介导轻度TBI和骨科损伤儿童中新发精神病的发生。 这项研究将促进更准确的预测，较早的鉴定并改善与轻度TBI有关的精神病并发症儿童的治疗。 公共卫生相关性：叙事小儿轻度创伤性脑损伤（TBI）是美国的主要公共卫生问题。这项研究将通过检查儿童，家庭和伤害危险因素来评估儿童新发育和骨科损伤后儿童新发育精神疾病的预测因素和机制。这项研究将促进更准确的预测，较早的鉴定并改善与轻度TBI有关的精神病并发症儿童的治疗。