Pediatric Traumatic Brain Injury in Latin America

拉丁美洲的小儿创伤性脑损伤

• 批准号: 8289698
• 负责人: NANCY A CARNEY
• 金额: $ 50.02万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-17 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8289698
• 关键词: Accounting; Acute; Address; Adherence; Adolescent; Adoption; Adult; American; Argentina; Award; Bolivia; Brain Diseases; Brain Injuries; Caring; Cause of Death; Certification; Characteristics; Child; Childhood; Childhood Injury; Clinical Research; Collaborations; Complex; Contracture; Country; Data; Decubitus ulcer; Developed Countries; Developing Countries; Development; Diagnostic; Ecuador; Education; Effectiveness; Employee; Environment; Epidemiology; Equipment; Family; Family member; Fostering; Funding; Generations; Grant; Guideline Adherence; Guidelines; Health; Healthcare Systems; Hospitals; Human Resources; Incidence; Income; Information Dissemination; Injury; Institution; International; Intervention; Intracranial Pressure; Investigation; Journals; Latin America; Lead; Life; Literature; Manuscripts; Medical; Modeling; Monitor; Morbidity - disease rate; Neurologic; Observational Study; Outcome; Pathology; Patient Care; Patients; Pediatric Hospitals; Peer Review; Phase; Pneumonia; Policy Maker; Population; Prevention; Prevention Guidelines; Prevention program; Prospective Studies; Public Health; Public Policy; Publications; Randomized; Randomized Controlled Trials; Recovery of Function; Registries; Rehabilitation therapy; Reporting; Research; Research Design; Research Training; Resources; Sampling; Schools; Sepsis; Services; Standardization; Stigmata; Structure; Survivors; TBI Patients; Testing; Time; Traffic accidents; Training; Training Programs; Trauma; Trauma Research; Traumatic Brain Injury; Treatment Protocols; Treatment outcome; Variant; Violence; Work; Writing; base; burden of illness; community living; design; disability; evidence base; evidence based guidelines; follow-up; functional outcomes; functional status; group intervention; improved; infant brain injury; mortality; patient home care; patient population; pediatric traumatic brain injury; prognostic; programs; prospective; social stigma; standard care; trauma centers

DESCRIPTION (provided by applicant): The incidence of traumatic brain injury (TBI) in Latin America is three times the international average. Worldwide, TBI is the leading cause of death and disability among children and adolescents. Mortality and morbidity due to non- neurological, secondary complications such as sepsis and pneumonia are high. There is little to no post-discharge rehabilitation for TBI, and follow-up care for these patients is rare. Treatment practices vary across centers and regions. Where resources allow, many centers use the Guidelines for the Acute Medical Management of TBI in Infants, Children, and Adolescents to guide their treatment decisions. Pilot data suggests that doing so may improve outcomes. There is an urgent need to conduct strong research about pediatric TBI in Latin America that can lead to diagnostics, treatment, and prevention. We propose to conduct a study of TBI in pediatric patients in Latin America. It will take place in five trauma centers; three in Argentina, one in Bolivia, and one in Ecuador. These centers represent the variation in resources available for treatment of TBI in Latin America. Our Specific Aims are: 1. In a randomized controlled trial, test the effect of a family-provided home care intervention on functional outcomes for pediatric patients who sustain moderate to severe TBI. 2. In a prospective, observational study, test the association between medical management and outcomes for pediatric patients with severe TBI. 3. In a prospective, observational study, test the association between resource availability and outcomes for pediatric patients with moderate to severe TBI. 4. Establish a registry of long-term, prospectively collected data about pediatric TBI in Latin America that can be used to generate strong scientific literature from which diagnostic, treatment, prognostic, and prevention guidelines - appropriate to resource-poor environments - can be derived. 5. Establish sustainable capacity in the Latin American Brain Injury Consortium (LABIC) to conduct ongoing research in pediatric populations with neurotrauma and other significant brain disorders. Our estimated sample is 720 acute care patients; we anticipate 65% will survive to discharge, and will collect outcomes data on approximately 420 patients (accounting for 10% loss to follow-up). We hypothesize that patients randomized to the home care intervention will have significantly better functional status than those who do not receive the intervention. We further hypothesize that outcome will be significantly associated with level of resources, and with medical management. PUBLIC HEALTH RELEVANCE: Traumatic brain injury (TBI) is of significant public health concern. Worldwide, it is the leading cause of death and disability among children and adolescents. Latin America has the highest incidence of intracranial injury in the world due to road traffic accidents and violence. The incidence of TBI in children in Latin America is almost three times higher than the international average. Rehabilitation for TBI is rare in most of Latin America - available only to the privileged or the employee-insured. Survivors are discharged to their families to live a life of disability, isolation, and stigma, with no follow-up care. The burden of illness is particularly poignant for pediatric TBI patients, as these children cannot return to school or engage in productive activities in their communities, but live many years completely dependent upon their families.

描述（由申请人提供）：拉丁美洲的创伤性脑损伤（TBI）发生率是国际平均水平的三倍。在世界范围内，TBI 是儿童和青少年死亡和残疾的主要原因。由于败血症和肺炎等非神经系统继发并发症导致的死亡率和发病率很高。 TBI 出院后几乎没有康复，这些患者的后续护理也很少。不同中心和地区的治疗方法有所不同。在资源允许的情况下，许多中心使用《婴儿、儿童和青少年 TBI 急性医疗管理指南》来指导他们的治疗决策。试点数据表明，这样做可能会改善结果。迫切需要对拉丁美洲的儿科 TBI 进行强有力的研究，以促进诊断、治疗和预防。我们提议对拉丁美洲的儿科患者进行 TBI 研究。它将在五个创伤中心进行；阿根廷 3 个，玻利维亚 1 个，厄瓜多尔 1 个。这些中心代表了拉丁美洲可用于治疗 TBI 的资源的差异。我们的具体目标是： 1. 在一项随机对照试验中，测试家庭提供的家庭护理干预对患有中度至重度 TBI 的儿科患者功能结果的影响。 2. 在一项前瞻性观察性研究中，测试严重 TBI 儿科患者的医疗管理与结果之间的关联。 3. 在一项前瞻性观察性研究中，测试资源可用性与中度至重度 TBI 儿科患者的结局之间的关联。 4. 建立一个长期、前瞻性收集的拉丁美洲儿科 TBI 数据登记册，可用于生成强有力的科学文献，从中得出适合资源匮乏环境的诊断、治疗、预后和预防指南。 5. 建立拉丁美洲脑损伤联盟 (LABIC) 的可持续能力，以对患有神经外伤和其他严重脑部疾病的儿科人群进行持续的研究。我们的估计样本是 720 名急症护理患者；我们预计 65% 的患者将存活到出院，并将收集大约 420 名患者的结果数据（占随访损失的 10%）。我们假设随机接受家庭护理干预的患者的功能状态将明显优于未接受干预的患者。我们进一步假设结果将与资源水平和医疗管理显着相关。公共卫生相关性：创伤性脑损伤 (TBI) 是一个重大的公共卫生问题。在世界范围内，它是儿童和青少年死亡和残疾的主要原因。拉丁美洲是世界上因道路交通事故和暴力造成颅内损伤发生率最高的地区。拉丁美洲儿童 TBI 的发病率几乎是国际平均水平的三倍。在拉丁美洲的大部分地区，创伤性脑损伤的康复服务很少见——只有特权阶层或雇员参保的人才能享受到这种服务。幸存者被出院与家人团聚，过着残疾、孤立和耻辱的生活，没有后续护理。疾病负担对于儿童 TBI 患者来说尤其令人痛苦，因为这些孩子无法重返学校或参与社区的生产活动，而是多年来完全依赖家人生活。