Anderson V A, Catroppa C, Haritou F, Morse S, Pentland L, Rosenfeld J, Stargatt R
Department of Psychology, University of Melbourne, Melbourne, Victoria 3010, Australia.
Pediatr Neurosurg. 2001 Mar;34(3):138-48. doi: 10.1159/000056009.
To examine the relative contributions of injury severity, level of physical and cognitive disability, child behavior and family function to short-term outcome 6 months following traumatic brain injury (TBI) in children.
Prospective, longitudinal, between-group design, comparing preinjury and postinjury measures of functional outcome across three levels of injury severity.
One hundred and twelve children, aged 2-12 years admitted to the Royal Children's Hospital, Melbourne, with a diagnosis of TBI. The sample was divided into three groups, according to injury severity: mild TBI (n = 31), moderate TBI (n = 52) and severe TBI (n = 29). Children with a history of neurologic, developmental and psychiatric disorder were excluded from participation.
Levels of postinjury functioning in the following domains: physical function, cognitive ability (incorporating intellect, memory and attention), behavioral and family functioning, and level of family burden.
A clear dose-response relationship for physical and cognitive outcomes was found, with severe TBI associated with greater impairment of physical, intellectual, memory and attentional function. For psychosocial outcome, results were less clearly linked to injury severity. Preinjury behavioral and family functioning were closely related to postinjury function in these domains, with an interaction identified between family function and child behavior at 6 months postinjury. Family functioning remained unchanged postinjury, although level of burden was high, and predicted by injury severity, functional impairment and postinjury behavioral disturbance.
These results suggest ongoing functional problems for the child and significant family burden 6 months following TBI. The nature and severity of physical and cognitive problems are most closely related to injury severity, with family functioning and child behavior better predicted by psychosocial and premorbid factors.
探讨损伤严重程度、身体和认知残疾水平、儿童行为及家庭功能对儿童创伤性脑损伤（TBI）后6个月短期预后的相对影响。
前瞻性纵向组间设计，比较三个损伤严重程度水平下伤前和伤后功能预后指标。
112名2至12岁因TBI诊断入住墨尔本皇家儿童医院的儿童。根据损伤严重程度将样本分为三组：轻度TBI（n = 31）、中度TBI（n = 52）和重度TBI（n = 29）。有神经、发育和精神疾病史的儿童被排除在外。
以下领域的伤后功能水平：身体功能、认知能力（包括智力、记忆和注意力）、行为和家庭功能以及家庭负担水平。
发现身体和认知结局存在明确的剂量反应关系，重度TBI与身体、智力、记忆和注意力功能的更大损伤相关。对于心理社会结局，结果与损伤严重程度的关联不太明显。伤前行为和家庭功能与这些领域的伤后功能密切相关，伤后6个月家庭功能与儿童行为之间存在相互作用。伤后家庭功能保持不变，尽管负担水平较高，且由损伤严重程度、功能损害和伤后行为障碍预测。
这些结果表明，TBI后6个月儿童存在持续的功能问题和显著的家庭负担。身体和认知问题的性质和严重程度与损伤严重程度关系最为密切，心理社会和病前因素能更好地预测家庭功能和儿童行为。
