Anderson Vicki, Catroppa Cathy, Morse Sue, Haritou Flora, Rosenfeld Jeffrey V
Department of Psychology, Royal Children's Hospital, Parkville, Victoria 3052, Australia.
Pediatrics. 2009 Dec;124(6):e1064-71. doi: 10.1542/peds.2009-0365.
Traumatic brain injury (TBI) is a common, acquired disability that may be used as a model to understand the impact of early brain injury on brain structure and function. To date, few studies have followed very young children over time after insult.
To plot recovery and outcome of intellectual ability after early TBI over the 5 years after injury, and to identify predictors of outcome including injury, sociodemographic and preinjury characteristics, and acute functional recovery.
Children aged between 2 and 7 years who were diagnosed with TBI (N = 54) were consecutively recruited on admission to the Royal Children's Hospital, Victoria, Australia, to participate in a prospective, longitudinal study. Our study had a between-factor design that used injury severity as the independent variable. The participants were categorized into groups according to injury severity (mild, moderate, or severe), and were compared with healthy control participants (n = 16) at the acute time point, and at 12 months, 30 months, and 5 years after injury. Intellectual measures, including verbal and nonverbal skills, attention, and processing speed, were administered.
Children with severe injuries demonstrated slower recovery and poorer cognitive outcomes up to 5 years after injury than did those who were observed for less severe injuries. Recovery trajectories were associated with injury severity over the first 30 months after injury, with the greatest deterioration in function observed for more severe injuries. From 30 months to 5 years after injury, progress was stable. Only injury severity (as determined by the Glasgow Coma Scale score) and acute cognitive performance were strong predictors of 5-year outcomes.
This study has confirmed the high risk of persisting and global deficits associated with severe brain insult in early childhood. Contrary to previous speculation about "growing into deficits," children with severe brain insults have more protracted recovery periods but do not continue to lose ground compared with their peers. By 30 months after insult, recovery seems to stabilize and children begin to make appropriate developmental gains.
创伤性脑损伤（TBI）是一种常见的后天性残疾，可作为了解早期脑损伤对脑结构和功能影响的模型。迄今为止，很少有研究对幼儿受伤后的长期情况进行跟踪。
描绘早期创伤性脑损伤后5年内智力能力的恢复情况和结果，并确定结果的预测因素，包括损伤情况、社会人口统计学和伤前特征以及急性功能恢复情况。
在澳大利亚维多利亚州皇家儿童医院收治的2至7岁被诊断为创伤性脑损伤的儿童（N = 54）被连续招募，参与一项前瞻性纵向研究。我们的研究采用组间因素设计，将损伤严重程度作为自变量。参与者根据损伤严重程度（轻度、中度或重度）进行分组，并在急性时间点以及受伤后12个月、30个月和5年时与健康对照参与者（n = 16）进行比较。进行了包括语言和非语言技能、注意力和处理速度在内的智力测量。
与损伤较轻的儿童相比，重伤儿童在受伤后长达5年的时间里恢复较慢，认知结果较差。恢复轨迹与受伤后最初30个月内的损伤严重程度相关，损伤越严重，功能恶化越明显。从受伤后30个月到5年，进展稳定。只有损伤严重程度（由格拉斯哥昏迷量表评分确定）和急性认知表现是5年结果的有力预测因素。
本研究证实了幼儿期严重脑损伤后持续存在全面缺陷的高风险。与之前关于“逐渐出现缺陷”的推测相反，严重脑损伤的儿童恢复期更长，但与同龄人相比不会继续退步。到受伤后30个月，恢复似乎稳定下来，儿童开始取得适当的发育进步。
