Truss Katherine, Godfrey Celia, Takagi Michael, Babl Franz E, Bressan Silvia, Hearps Stephen, Clarke Cathriona, Dunne Kevin, Anderson Vicki
1 Murdoch Childrens Research Institute , Melbourne, Australia .
2 School of Psychological Sciences, University of Melbourne , Melbourne, Australia .
J Neurotrauma. 2017 Jul 15;34(14):2272-2279. doi: 10.1089/neu.2016.4842. Epub 2017 May 3.
A substantial minority of children experience post-traumatic stress symptoms (PTSS) following injury. Research indicates variation in the trajectory of PTSS following pediatric injury, but investigation of PTSS following concussion has assumed homogeneity. This study aimed to identify differential trajectories of PTSS following pediatric concussion and to investigate risk factors, including acute post-concussive symptoms (PCS), associated with these trajectories. A total of 120 children ages 8-18 years reported PTSS for 3 months following concussion diagnosis using the Child PTSD Symptom Scale, with a score of 16 or above indicating probable post-traumatic stress disorder diagnosis. Age, gender, injury mechanism, loss of consciousness, previous concussions, prior hospitalization, prior diagnosis of depression or anxiety, and acute PCS were assessed as risk factors. Data were analyzed using group-based trajectory modeling. Results revealed 16% of children had clinically significant PTSS 2 weeks post-concussion, declining to 10% at 1 month and 6% at 3 months post-injury. Group-based trajectory modeling identified three trajectories of PTSS post-concussion: "resilient" (70%); "recovering" (25%), in which children experienced elevated acute symptoms that declined over time; and "chronic symptomatology" (5%). Due to small size, the chronic group should be interpreted with caution. Higher acute PCS and prior diagnosis of depression or anxiety both significantly increased predicted probability of recovering trajectory group membership. These findings establish that most children are resilient to PTSS following concussion, but that PTSS do occur acutely in a substantial minority of children. The study indicates mental health factors, particularly PTSS, depression, and anxiety, should be considered integral to models of concussion management and treatment.
相当一部分儿童在受伤后会出现创伤后应激症状（PTSS）。研究表明，小儿受伤后PTSS的发展轨迹存在差异，但对脑震荡后PTSS的研究一直假定其具有同质性。本研究旨在确定小儿脑震荡后PTSS的不同发展轨迹，并调查与这些轨迹相关的风险因素，包括急性脑震荡后症状（PCS）。共有120名8至18岁的儿童在脑震荡诊断后的3个月内使用儿童创伤后应激障碍症状量表报告了PTSS，得分16分及以上表明可能被诊断为创伤后应激障碍。年龄、性别、受伤机制、意识丧失、既往脑震荡史、既往住院史、既往抑郁或焦虑诊断以及急性PCS被评估为风险因素。使用基于群体的轨迹模型对数据进行分析。结果显示，16%的儿童在脑震荡后2周出现具有临床意义的PTSS，受伤后1个月降至10%，3个月降至6%。基于群体的轨迹模型确定了脑震荡后PTSS的三种轨迹：“恢复力强型”（70%）；“恢复型”（25%），即儿童经历的急性症状随着时间推移而下降；以及“慢性症状型”（5%）。由于样本量小，对慢性症状型组的解释应谨慎。较高的急性PCS以及既往抑郁或焦虑诊断均显著增加了属于恢复轨迹组的预测概率。这些发现表明，大多数儿童在脑震荡后对PTSS具有恢复力，但仍有相当一部分儿童会急性发作PTSS。该研究表明，心理健康因素，尤其是PTSS、抑郁和焦虑，应被视为脑震荡管理和治疗模型的重要组成部分。
