Grubenhoff Joseph A, Currie Dustin, Comstock R Dawn, Juarez-Colunga Elizabeth, Bajaj Lalit, Kirkwood Michael W
Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
Colorado School of Public Health, Aurora, CO.
J Pediatr. 2016 Jul;174:27-32.e1. doi: 10.1016/j.jpeds.2016.03.027. Epub 2016 Apr 11.
To characterize the psychological factors associated with persistent symptoms after pediatric concussion.
Longitudinal cohort study of 179 children with concussion 8-18 years old evaluated in a pediatric emergency department. Participants were followed for 1 month for delayed symptom resolution, defined as ≥3 symptoms that were new/worse than preinjury symptoms measured by the use of graded symptom inventory. Preinjury psychological traits were measured by parental report on subscales of the Personality Inventory for Children-2 (maladjustment, cognitive abilities, somatization). Child report of postinjury anxiety and injury perception were measured with the State-Trait Anxiety Inventory for Children and Children's Illness Perception Questionnaire. Psychological instrument scores were compared between those with and without delayed symptom resolution via a Kruskal-Wallis test. Associations between psychological traits and delayed symptom resolution were investigated by the use of logistic regression.
Delayed symptom resolution occurred in 21% of participants. Score distributions were significantly worse on the State-Trait Anxiety Inventory for Children (38 [IQR 33-40] vs 35 [IQR 31-39]; P = .04) and somatization subscale (1 [IQR 0-3] vs 1 [IQR 0-1]; P = .01) among children with delayed symptom resolution compared with children with early symptom resolution. Somatization was associated with delayed symptom resolution (aOR 1.35, 95% CI 1.08-1.69). The proportion of children with abnormal somatization scores was significantly greater in the delayed symptom resolution group (34.2%) than the early symptom resolution group (12.8%; P < .01). Other psychological measures were not different between groups.
Somatization is associated with delayed symptom resolution in this cohort of children with concussion. Postconcussive symptoms lasting at least 1 month may warrant referral to a neuropsychologist familiar with postconcussion care.
明确小儿脑震荡后持续症状相关的心理因素。
对在儿科急诊科接受评估的179名8至18岁脑震荡儿童进行纵向队列研究。对参与者随访1个月，观察症状延迟缓解情况，症状延迟缓解定义为使用分级症状量表测量出≥3种新出现的或比受伤前症状更严重的症状。受伤前心理特征通过父母对儿童人格问卷-2（适应不良、认知能力、躯体化）分量表的报告来测量。受伤后儿童的焦虑和对损伤的认知通过儿童状态-特质焦虑量表和儿童疾病认知问卷来测量。通过Kruskal-Wallis检验比较症状延迟缓解组和未延迟缓解组的心理测量工具得分。使用逻辑回归研究心理特征与症状延迟缓解之间的关联。
21%的参与者出现症状延迟缓解。与症状早期缓解的儿童相比，症状延迟缓解的儿童在儿童状态-特质焦虑量表上的得分分布明显更差（38[四分位间距33 - 40]对35[四分位间距31 - 39]；P = 0.04），在躯体化分量表上也是如此（1[四分位间距0 - 3]对1[四分位间距0 - 1]；P = 0.01）。躯体化与症状延迟缓解相关（调整后比值比1.35，95%置信区间1.08 - 1.69）。症状延迟缓解组中躯体化得分异常的儿童比例（34.2%）明显高于症状早期缓解组（12.8%；P < 0.01）。其他心理测量指标在两组之间没有差异。
在这个脑震荡儿童队列中，躯体化与症状延迟缓解相关。脑震荡后症状持续至少1个月可能需要转诊给熟悉脑震荡后护理的神经心理学家。
