Ewing-Cobbs Linda, Prasad Mary R, Kramer Larry, Cox Charles S, Baumgartner James, Fletcher Stephen, Mendez Donna, Barnes Marcia, Zhang Xiaoling, Swank Paul
Department of Pediatrics, University of Texas Health Science Center at Houston, 70030, USA.
J Neurosurg. 2006 Oct;105(4 Suppl):287-96. doi: 10.3171/ped.2006.105.4.287.
Although long-term neurological outcomes after traumatic brain injury (TBI) sustained early in life are generally unfavorable, the effect of TBI on the development of academic competencies is unknown. The present study characterizes intelligence quotient (IQ) and academic outcomes an average of 5.7 years after injury in children who sustained moderate to severe TBI prior to 6 years of age.
Twenty-three children who suffered inflicted or noninflicted TBI between the ages of 4 and 71 months were enrolled in a prospective, longitudinal cohort study. Their mean age at injury was 21 months; their mean age at assessment was 89 months. The authors used general linear modeling approaches to compare IQ and standardized academic achievement test scores from the TBI group and a community comparison group (21 children). Children who sustained early TBI scored significantly lower than children in the comparison group on intelligence tests and in the reading, mathematical, and language domains of achievement tests. Forty-eight percent of the TBI group had IQs below the 10th percentile. During the approximately 5-year follow-up period, longitudinal IQ testing revealed continuing deficits and no recovery of function. Both IQ and academic achievement test scores were significantly related to the number of intracranial lesions and the lowest postresuscitation Glasgow Coma Scale score but not to age at the time of injury. Nearly 50% of the TBI group failed a school grade and/or required placement in self-contained special education classrooms; the odds of unfavorable academic performance were 18 times higher for the TBI group than the comparison group.
Traumatic brain injury sustained early in life has significant and persistent consequences for the development of intellectual and academic functions and deleterious effects on academic performance.
尽管早年遭受创伤性脑损伤（TBI）后的长期神经学预后通常不佳，但TBI对学术能力发展的影响尚不清楚。本研究对6岁之前遭受中度至重度TBI的儿童在受伤后平均5.7年的智商（IQ）和学业成绩进行了特征描述。
23名在4至71个月大时遭受外伤性或非外伤性TBI的儿童被纳入一项前瞻性纵向队列研究。他们受伤时的平均年龄为21个月；评估时的平均年龄为89个月。作者使用一般线性模型方法比较了TBI组和社区对照组（21名儿童）的IQ和标准化学业成绩测试分数。早期遭受TBI的儿童在智力测试以及成绩测试的阅读、数学和语言领域的得分显著低于对照组儿童。TBI组中有48%的儿童IQ低于第10百分位。在大约5年的随访期内，纵向IQ测试显示持续存在缺陷且功能未恢复。IQ和学业成绩测试分数均与颅内病变数量及复苏后最低格拉斯哥昏迷量表评分显著相关，但与受伤时的年龄无关。TBI组中近50%的儿童留级和/或需要进入独立的特殊教育教室；TBI组学业成绩不佳的几率比对照组高18倍。
早年遭受的创伤性脑损伤对智力和学术功能的发展具有重大且持久的影响，并对学业成绩产生有害作用。
