University of Cincinnati College of Medicine, Ohio (Drs Wade, Narad, and Zhang and Mr Zang); College of Arts and Science, University of Cincinnati, Ohio (Dr Wade and Mrs Moscato); Divisions of Pediatric Rehabilitation Medicine (Drs Wade and Aguilar and Ms Miley and Mrs Moscato), Behavioral Medicine and Clinical Psychology (Dr Narad), Biostatics and Epidemiology (Mr Zang and Dr Zhang), and Physical Medicine and Rehabilitation (Dr Kurowski), Cincinnati Children's Hospital Medical Center, Ohio; Departments of Statistics (Dr Kaizar) and Pediatrics (Dr Taylor), The Ohio State University, Columbus; Departments of Pediatrics, Neurology and Rehabilitation Medicine, University of Cincinnati, Ohio (Dr Kurowski); Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, Calgary, Canada (Dr Yeates); and Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Dr Taylor).
J Head Trauma Rehabil. 2020 Sep/Oct;35(5):E393-E404. doi: 10.1097/HTR.0000000000000567.
To examine the frequency of behavioral problems after childhood traumatic brain injury (TBI) and their associations with injury severity, sex, and social environmental factors.
Children's hospitals in the Midwestern/Western United States.
381 boys and 210 girls with moderate (n = 359) and severe (n = 227) TBI, with an average age at injury of 11.7 years (range 0.3-18) who were injured ≤3 years ago.
Secondary data analysis of a multistudy cohort.
Child Behavior Checklist (CBCL) administered pretreatment.
Thirty-seven percent had borderline/clinical elevations on the CBCL Total Problem Scale, with comparable rates of Internalizing and Externalizing problems (33% and 31%, respectively). Less parental education was associated with higher rates of internalizing, externalizing, and total problems. Time since injury had a linear association with internalizing symptoms, with greater symptoms at longer postinjury intervals. Younger boys had significantly higher levels of oppositional defiant symptoms than girls, whereas older girls had significantly greater attention-deficit hyperactivity disorder symptoms than boys.
Pediatric TBI is associated with high rates of behavior problems, with lower socioeconomic status predicting substantially elevated risk. Associations of higher levels of internalizing symptoms with greater time since injury highlight the importance of tracking children over time.
探讨儿童创伤性脑损伤（TBI）后行为问题的发生频率及其与损伤严重程度、性别和社会环境因素的关系。
美国中西部/西部的儿童医院。
381 名患有中度（n=359）和重度（n=227）TBI 的男孩和 210 名女孩，平均受伤年龄为 11.7 岁（范围 0.3-18 岁），且受伤时间不超过 3 年。
多研究队列的二次数据分析。
在治疗前进行儿童行为检查表（CBCL）评估。
37%的患儿在 CBCL 总分量表上存在边缘/临床升高，内隐和外显问题的发生率相当（分别为 33%和 31%）。父母教育程度较低与更高的内隐、外显和总问题发生率相关。受伤后时间与内隐症状呈线性相关，受伤后间隔时间越长，症状越严重。与女孩相比，年龄较小的男孩对立违抗症状水平显著更高，而年龄较大的女孩注意缺陷多动障碍症状水平显著高于男孩。
儿科 TBI 与行为问题的高发生率相关，社会经济地位较低预示着风险显著增加。与内隐症状水平较高相关的时间间隔较长突显了随时间跟踪儿童的重要性。
