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

基本信息

批准号：
8326616
负责人：
JEFFREY Edwin MAX
金额：
$ 61.18万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
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/8326616
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

项目摘要

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.

描述（由申请人提供）：轻度创伤性脑损伤（TBI）是美国的一个主要公共卫生问题。虽然众所周知，患有严重创伤性脑损伤的儿童患新的精神疾病的风险很高，但对轻度创伤性脑损伤儿童的研究却受到方法学问题的困扰，导致结果相互矛盾并引发争议。没有一项关于儿科轻度 TBI 的精神病学研究不存在与轻度 TBI 的定义、对照组、结果测量、纵向设计、选择偏倚、样本量或伤害和心理社会危险因素评估相关的问题。该项目的总体目标是研究轻度 TBI 儿童发生新精神疾病的损伤和社会心理危险因素。拟议的研究将涉及一项为期 1 年、4 次评估的前瞻性纵向研究，研究对象为接受连续治疗的轻度 TBI 受伤儿童 (n=220) 和对照组，其中包括不涉及大脑的轻度骨科损伤儿童 (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、学业成绩、智力功能、家庭精神病史和家庭功能。将使用高分辨率结构磁共振成像（MRI）来定义病变识别、病变定位、病变体积、区域体积和白质完整性测量。 MRI 分析将包括扩散张量成像、磁化率加权成像、T2 加权成像和液体衰减反转恢复成像。该研究将检验三个主要假设：（1）与骨科对照组相比，患有轻度 TBI 的儿童新发精神疾病的发生率明显更高。 (2) 儿童新发精神疾病将通过儿童变量（受伤前的儿童适应功能、受伤前的学业和认知功能以及受伤前的终生精神疾病）和受伤前的家庭变量（社会因素）来预测。轻度 TBI 和骨科损伤儿童的经济状况、受伤前家庭功能和生活事件、家庭精神病史）。 (3) 对于轻度 TBI 和骨科损伤的儿童，新发精神疾病的发生将由儿童受伤后应对策略和受伤后家庭变量（功能和压力源）介导。此外，损伤变量（严重程度、脑损伤的存在、弥漫性轴突损伤的程度）将介导轻度 TBI 和骨科损伤儿童新发精神疾病的发生。这项研究将促进对患有轻度 TBI 相关精神并发症的儿童进行更准确的预测、更早的识别和更好的治疗。