Faris Gregory, Byczkowski Terri, Ho Mona, Babcock Lynn
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Acad Pediatr. 2016 May-Jun;16(4):336-42. doi: 10.1016/j.acap.2015.10.007. Epub 2015 Oct 30.
To evaluate the ability of risk strata generated by a neuroimaging rule, developed to assess risk of clinically important traumatic brain injury (ciTBI), to predict postconcussive symptoms in youth with an acute mild traumatic brain injury.
We performed a prospective cohort study of youth aged 5 to 17 years presenting to an emergency department (ED) within 24 hours of mild traumatic brain injury. Risk strata (very low, intermediate, and at risk) of ciTBI were determined in ED by criteria set forth by the neuroimaging rule. Postconcussive symptoms were assessed using the Health and Behavior Inventory (HBI) in the ED and at 1, 2, and 4 weeks after injury. General linear models were used to examine the relationship between the HBI score at 1 week and risk strata. Repeated measures analysis was used to measure change in HBI over time.
Of the 120 participants, 46 were categorized by the Pediatric Emergency Care Applied Research Network (PECARN) rule as very low risk, 39 as intermediate risk, and 35 as at risk for ciTBI. Adjusted mean HBI scores (95% confidence intervals) at 1 week were 18.0 (13.9, 22.2) for at risk, 13.8 (9.9, 17.6) for intermediate risk, and 17.1 (13.4, 20.8) for very low risk. Risk strata were not significantly associated with the adjusted HBI score at 1 week (P = .17). While adjusted HBI scores declined significantly over time (P < .0001), the trajectories of the HBI score over time did not differ significantly by risk strata (P = .68).
Risk of ciTBI as determined by factors within a neuroimaging rule alone is insufficient to predict children with persistent postconcussive symptoms.
评估一种神经影像学规则所生成的风险分层在预测急性轻度创伤性脑损伤（TBI）青少年患者脑震荡后症状方面的能力，该规则旨在评估具有临床意义的创伤性脑损伤（ciTBI）的风险。
我们对5至17岁在轻度创伤性脑损伤后24小时内就诊于急诊科（ED）的青少年进行了一项前瞻性队列研究。在急诊科根据神经影像学规则设定的标准确定ciTBI的风险分层（极低、中等和有风险）。在急诊科以及受伤后1周、2周和4周使用健康与行为量表（HBI）评估脑震荡后症状。采用一般线性模型检验1周时HBI评分与风险分层之间的关系。采用重复测量分析来测量HBI随时间的变化。
在120名参与者中，根据儿科急诊护理应用研究网络（PECARN）规则，46名被归类为ciTBI极低风险，39名属于中等风险，35名有ciTBI风险。1周时调整后的平均HBI评分（95%置信区间），有风险组为18.0（13.9，22.2），中等风险组为13.8（9.9，17.6），极低风险组为17.1（13.4，20.8）。风险分层与1周时调整后的HBI评分无显著相关性（P = .17）。虽然调整后的HBI评分随时间显著下降（P < .0001），但HBI评分随时间的轨迹在不同风险分层之间无显著差异（P = .68）。
仅由神经影像学规则中的因素所确定的ciTBI风险不足以预测有持续性脑震荡后症状的儿童。
