A Risk Stratification Model for Health and Academic Outcomes in Children with Concussion Based on Novel Symptom Trajectory Typologies

基于新症状轨迹类型的脑震荡儿童健康和学业成果的风险分层模型

基本信息

批准号：
10560681
负责人：
KARIN REUTER-RICE
金额：
$ 65.63万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-03-01 至 2028-02-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10560681
关键词：
Absenteeism Adult Affect Age American Biological Biological Markers Brain Concussion Brain Injuries Characteristics Child Childhood Clinical Cognitive Data Development Diagnosis Early identification Economic Burden Emergency department visit Emotional Family Fatigue Genes Goals Growth Health Healthcare Systems Inflammatory Injury Intervention Learning Link Measures Modeling Neurobehavioral Manifestations Outcome Patient Outcomes Assessments Patient Self-Report Pattern Performance Play Population Heterogeneity Post-Concussion Syndrome Process Public Health Quality of life Reporting Research Risk Schools Severities Sex Distribution Social Behavior Social Well-Being Social isolation Social outcome Symptoms Time Typology United States National Institutes of Health Variant Well in self Work acute symptom care outcomes clinical care clinical prognostic cognitive function concussive symptom cost estimate cytokine demographics disparity reduction emotional symptom ethnic diversity evidence base experience health care delivery health disparity health economics high risk improved improved outcome insight meetings novel outcome disparities peer persistent symptom personalized care personalized health care physical symptom psychologic psychological distress racial diversity response risk stratification social social factors societal costs socioeconomics symptom management symptom science

项目摘要

ABSTRACT. Concussions occur at an alarming rate among U.S. schoolchildren, with one in five children experiencing a concussion by age 16. The number of children visiting emergency departments for concussions annually has increased by 50% over the past decade, with an estimated cost to the healthcare system of $1 billion/year. Compared to adults, children experience longer and more severe postconcussive symptoms (PCS). Severity and duration of PCS, however, vary considerably among children, complicating clinical care and return to learn and play. Persistent PCS including physical, emotional, and cognitive symptoms, result in increased school absenteeism, social isolation, and psychological distress. Early PCS diagnosis and access to evidence-based return-to-health and -school interventions are strongly linked to positive health and academic outcomes. Yet models to identify children at high risk for persistent PCS are lacking. PCS have been linked to inflammatory processes occurring within the injured brain. Preliminary evidence suggests that fatigue, another symptom likely contributing to poor outcomes, is also a biological byproduct of pediatric concussions. Importantly, even though 73% of children report continuous fatigue after concussion, this symptom is rarely studied along with other PCS. Prior research has focused on the relationship between inflammatory biomarkers and PCS severity but has not examined this relationship longitudinally. Acute symptom severity alone, however, is a poor prognostic of clinical outcomes in concussed children. Symptom severity immediately postinjury does not explain why at least 25% of children still experience PCS after 1 year or why even children who may appear asymptomatic still report academic and social challenges months after concussion. To identify which children are at high risk for persistent PCS and poor health, academic, and social outcomes, research tracking PCS trajectories and describing school-based impacts across the entire first year postinjury is critically needed. This proposal will 1) define novel PCS trajectory typologies in a racially/ethnically diverse population of 500 children with concussion (11–17 years, near equal distribution by sex), 2) identify associations between these typologies and patterns of inflammatory biomarkers, 3) develop a risk stratification model to identify children at risk for persistent PCS; and 4) gain unique insights and describe PCS impact, including fatigue, on longer-term academic and social outcomes. We will be the first to use NIH's symptom science model and patient-reported outcomes to explore the patterns of fatigue and other physical, cognitive, psychological, emotional and academic responses to concussion in children over a full year. Our model will enable clinicians and educators to identify children most at risk for poor long-term health, social, and academic outcomes after concussion. This work is critical to meeting our long-term goal of developing personalized concussion symptom- management strategies to improve outcomes and reduce disparities in the health and quality of life of children.

抽象的。美国学童中脑震荡的发生率惊人，五分之一的儿童经历过脑震荡 16 岁时就患有脑震荡。每年因脑震荡而去急诊室就诊的儿童人数过去十年增加了 50%，估计医疗保健系统每年的成本为 10 亿美元。与成人相比，儿童经历的脑震荡后症状 (PCS) 时间更长、更严重。然而，儿童 PCS 的发生率和持续时间差异很大，这使得临床护理和重返学习变得复杂持续的 PCS（包括身体、情绪和认知症状）会导致学校时间增加。缺勤、社会孤立和心理困扰。早期 PCS 诊断和获得循证证据。然而，恢复健康和学校干预措施与积极的健康和学业成果密切相关。目前尚缺乏识别患有持续性 PCS 高风险儿童的模型，该模型与炎症有关。初步证据表明，疲劳是另一个症状。甚至可能导致不良结果，也是儿科脑震荡的生物副产品。尽管 73% 的儿童报告脑震荡后持续疲劳，但很少对这种症状与其他 PCS 先前的研究重点是炎症生物标志物与 PCS 严重程度之间的关系。但尚未单独检查这种纵向关系，但是，急性症状严重程度的关系很差。受伤后症状的严重程度并不能直接预测脑震荡儿童的临床结果。解释为什么至少 25% 的儿童在 1 年后仍然经历 PCS，或者为什么即使是可能出现 PCS 的儿童无症状的儿童在脑震荡几个月后仍报告学业和社会挑战。患有持续性 PCS 以及健康状况、学业和社会结果不佳的高风险，跟踪 PCS 的研究迫切需要了解受伤后整个第一年的轨迹并描述基于学校的影响。提案将 1) 在 500 名儿童的种族/民族多样化人群中定义新颖的 PCS 轨迹类型脑震荡（11-17 岁，按性别分布几乎相等），2) 确定这些之间的关联炎症生物标志物的类型和模式，3) 开发风险分层模型来识别儿童持续性 PCS 的风险；以及 4) 获得独特的见解并描述 PCS 的长期影响，包括疲劳我们将成为第一个使用 NIH 症状科学模型和患者报告的人。结果探索疲劳模式以及其他身体、认知、心理、情感和我们的模型将为学徒和教育工作者提供一整年对儿童脑震荡的学术反应。确定脑震荡后最有可能出现长期健康、社会和学业成绩不佳风险的儿童。这项工作对于实现我们开发个性化脑震荡症状的长期目标至关重要改善结果并减少儿童健康和生活质量差异的管理战略。