Goh Mark Sen Liang, Looi Dawn Shu Hui, Goh Jia Ling, Sultana Rehena, Goh Sharon Si Min, Lee Jan Hau, Chong Shu-Ling
Duke-NUS Medical School, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
J Neurol Neurosurg Psychiatry. 2021 Mar 31. doi: 10.1136/jnnp-2020-325066.
To assess the burden of paediatric traumatic brain injury (TBI) on neurocognition via a systematic review and meta-analysis.
Studies that compared neurocognitive outcomes of paediatric patients with TBI and controls were searched using Medline, Embase, PsycINFO and Cochrane Central Register of Controlled Trials, between January 1988 and August 2019. We presented a random-effects model, stratified by TBI severity, time of assessment post injury and age.
Of 5919 studies, 41 (patients=3717) and 33 (patients=3118) studies were included for the systematic review and meta-analysis, respectively. Studies mostly measured mild TBI (n=26, patients=2888) at 0-3 months postinjury (n=17, patients=2502). At 0-3 months postinjury, standardised mean differences between TBI and controls for executive function were -0.04 (95% CI -0.14 to 0.07; I=0.00%), -0.18 (95% CI -0.29 to -0.06; I=26.1%) and -0.95 (95% CI -1.12 to -0.77; I=10.1%) for mild, moderate and severe TBI, respectively; a similar effect was demonstrated for learning and memory. Severe TBI had the worst outcomes across all domains and persisted >24 months postinjury. Commonly used domains differed largely from workgroup recommendations. Risk of bias was acceptable for all included studies.
A dose-dependent relationship between TBI severity and neurocognitive outcomes was evident in executive function and in learning and memory. Cognitive deficits were present for TBIs of all severity but persisted among children with severe TBI. The heterogeneity of neurocognitive scales makes direct comparison between studies difficult. Future research into lesser explored domains and a more detailed assessment of neurocognitive deficits in young children are required to better understand the true burden of paediatric TBI.
通过系统评价和荟萃分析评估小儿创伤性脑损伤（TBI）对神经认知的负担。
在1988年1月至2019年8月期间，使用Medline、Embase、PsycINFO和Cochrane对照试验中央登记册检索比较小儿TBI患者与对照组神经认知结果的研究。我们提出了一个随机效应模型，按TBI严重程度、受伤后评估时间和年龄分层。
在5919项研究中，分别有41项（患者 = 3717）和33项（患者 = 3118）研究纳入系统评价和荟萃分析。研究大多在受伤后0 - 3个月测量轻度TBI（n = 26，患者 = 2888）（n = 17，患者 = 2502）。在受伤后0 - 3个月，轻度、中度和重度TBI的TBI与对照组在执行功能方面的标准化平均差异分别为 -0.04（95%CI -0.14至0.07；I² = 0.00%）、-0.18（95%CI -0.29至 -0.06；I² = 26.1%）和 -0.95（95%CI -1.12至 -0.77；I² = 10.1%）；学习和记忆方面也显示出类似的效果。重度TBI在所有领域的结果最差，且在受伤后持续超过24个月。常用领域与工作组建议有很大差异。所有纳入研究的偏倚风险均可接受。
TBI严重程度与执行功能以及学习和记忆方面的神经认知结果之间存在剂量依赖关系。所有严重程度的TBI均存在认知缺陷，但在重度TBI儿童中持续存在。神经认知量表的异质性使得研究之间难以直接比较。需要对较少探索的领域进行未来研究，并对幼儿神经认知缺陷进行更详细的评估，以更好地了解小儿TBI的真正负担。
