Barlow Karen M, Thomson Elaine, Johnson David, Minns Robert A
University of Calgary, Alberta Children's Hospital, 1820 Richmond Rd, Calgary, Alberta, T2T 5C7, Canada.
Pediatrics. 2005 Aug;116(2):e174-85. doi: 10.1542/peds.2004-2739.
There is limited information regarding the long-term outcome of inflicted traumatic brain injury (TBI), including shaken infant syndrome. The purpose of this study was to describe the long-term neurologic, behavioral, and cognitive sequelae seen in this population.
A cross-sectional and prospective longitudinal study was conducted of 25 children with inflicted TBI in Scotland between 1980 and 1999. After consent was obtained, neurologic and cognitive examinations were performed on all participants and sequentially in the prospective cohort. Two global outcome measures were used: Glasgow Outcome Score (GOS) and Seshia's outcome score. Cognitive outcome was assessed using the Bayley Scales of Infant Development, British Ability Scales, and the Vineland Adaptive Behavior Scales.
The mean length of follow-up was 59 months. A total of 68% of survivors were abnormal on follow-up, 36% had severe difficulties and were totally dependant, 16% had moderate difficulties, and 16% had mild difficulties on follow-up. A wide range of neurologic sequelae were seen, including motor deficits (60%), visual deficits (48%), epilepsy (20%), speech and language abnormalities (64%), and behavioral problems (52%). There was a wide range of cognitive abilities: the mean psychomotor index, 69.9 (SD: +/-25.73); and mean mental development index, 74.53 (SD: +/-28.55). Adaptive functioning showed a wide range of difficulties across all domains: communication domain (mean: 76.1; SD: +/-25.4), Daily living skills domain (mean: 76.9; SD: +/-24.3), and socialization domain (mean: 79.1; SD: +/-23.1). Outcome was found to correlate with the Pediatric Trauma Score and the Glasgow Coma Score but did not correlate with age at injury or mechanism of injury.
Inflicted TBI has a very poor prognosis and correlates with severity of injury. Extended follow-up is necessary so as not to underestimate problems such as specific learning difficulties and attentional and memory problems that may become apparent only once the child is in school. Behavioral problems are present in 52% and begin to manifest clinically between the second and third years of life, although the consequences of frontal lobe injury may be underestimated unless follow-up is extended into adolescence and early adulthood.
关于包括摇晃婴儿综合征在内的外伤性脑损伤（TBI）的长期预后，相关信息有限。本研究的目的是描述该人群中出现的长期神经、行为和认知后遗症。
对1980年至1999年间在苏格兰的25名患有外伤性脑损伤的儿童进行了横断面和前瞻性纵向研究。在获得同意后，对所有参与者进行了神经和认知检查，并在前瞻性队列中依次进行。使用了两种总体结局测量方法：格拉斯哥结局评分（GOS）和塞西亚结局评分。使用贝利婴儿发育量表、英国能力量表和文兰适应行为量表评估认知结局。
平均随访时间为59个月。共有68%的幸存者在随访时异常，36%有严重困难且完全依赖他人，16%有中度困难，16%在随访时有轻度困难。观察到广泛的神经后遗症，包括运动缺陷（60%）、视觉缺陷（48%）、癫痫（20%）、言语和语言异常（64%）以及行为问题（52%）。认知能力范围广泛：平均心理运动指数为69.9（标准差：±25.73）；平均智力发育指数为74.53（标准差：±28.55）。适应功能在所有领域都表现出广泛的困难：沟通领域（平均：76.1；标准差：±25.4）、日常生活技能领域（平均：76.9；标准差：±24.3）和社交领域（平均：79.1；标准差：±23.1）。发现结局与儿科创伤评分和格拉斯哥昏迷评分相关，但与受伤年龄或受伤机制无关。
外伤性脑损伤预后很差，且与损伤严重程度相关。需要进行长期随访，以免低估诸如特定学习困难以及注意力和记忆问题等，这些问题可能只有在孩子上学后才会显现出来。52%的患者存在行为问题，且在生命的第二年和第三年之间开始在临床上表现出来，但除非随访延长至青春期和成年早期，否则额叶损伤的后果可能会被低估。
