Bonfield Christopher M, Lam Sandi, Lin Yimo, Greene Stephanie
Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania 15224, USA.
J Neurosurg Pediatr. 2013 Aug;12(2):97-102. doi: 10.3171/2013.5.PEDS12424. Epub 2013 Jun 25.
Attention deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) are significant independent public health concerns in the pediatric population. This study explores the impact of a premorbid diagnosis of ADHD on outcome following mild TBI.
The charts of all patients with a diagnosis of mild closed head injury (CHI) and ADHD who were admitted to Children's Hospital of Pittsburgh between January 2003 and December 2010 were retrospectively reviewed after institutional review board approval was granted. Patient demographics, initial Glasgow Coma Scale (GCS) score, hospital course, and King's Outcome Scale for Childhood Head Injury (KOSCHI) score were recorded. The results were compared with a sample of age-matched controls admitted with a diagnosis of CHI without ADHD.
Forty-eight patients with mild CHI and ADHD, and 45 patients with mild CHI without ADHD were included in the statistical analysis. Mild TBI due to CHI was defined as an initial GCS score of 13-15. The ADHD group had a mean age of 12.2 years (range 6-17 years), and the control group had a mean age of 11.14 years (range 5-16 years). For patients with mild TBI who had ADHD, 25% were moderately disabled (KOSCHI Score 4b), and 56% had completely recovered (KOSCHI Score 5b) at follow-up. For patients with mild TBI without ADHD, 2% were moderately disabled and 84% had completely recovered at follow-up (p < 0.01). Patients with ADHD were statistically significantly more disabled after mild TBI than were control patients without ADHD, even when controlling for age, sex, initial GCS score, hospital length of stay, length of follow-up, mechanism of injury, and presence of other (extracranial) injury.
Patients who sustain mild TBIs in the setting of a premorbid diagnosis of ADHD are more likely to be moderately disabled by the injury than are patients without ADHD.
注意缺陷多动障碍（ADHD）和创伤性脑损伤（TBI）是儿科人群中重要的独立公共卫生问题。本研究探讨病前诊断为ADHD对轻度TBI后预后的影响。
在获得机构审查委员会批准后，对2003年1月至2010年12月期间入住匹兹堡儿童医院且诊断为轻度闭合性颅脑损伤（CHI）和ADHD的所有患者的病历进行回顾性审查。记录患者的人口统计学资料、初始格拉斯哥昏迷量表（GCS）评分、住院病程以及儿童头部损伤国王预后量表（KOSCHI）评分。将结果与诊断为CHI但无ADHD的年龄匹配对照组样本进行比较。
48例轻度CHI合并ADHD患者和45例轻度CHI不合并ADHD患者纳入统计分析。因CHI导致的轻度TBI定义为初始GCS评分为13 - 15分。ADHD组的平均年龄为12.2岁（范围6 - 17岁），对照组的平均年龄为11.14岁（范围5 - 16岁）。对于患有ADHD的轻度TBI患者，25%在随访时为中度残疾（KOSCHI评分4b），56%已完全康复（KOSCHI评分5b）。对于无ADHD的轻度TBI患者，2%为中度残疾，84%在随访时已完全康复（p < 0.01）。即使在控制年龄、性别、初始GCS评分、住院时间、随访时间、损伤机制以及其他（颅外）损伤的存在等因素后，患有ADHD的患者在轻度TBI后在统计学上比无ADHD的对照患者残疾程度更显著。
病前诊断为ADHD的情况下发生轻度TBI的患者比无ADHD的患者更容易因损伤而出现中度残疾。
