Laaksonen Juho, Ponkilainen Ville, Möttönen Julius, Mattila Ville M, Kuitunen Ilari
Department of Clinical Medicine, University of Tampere, Tampere, Finland.
Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland.
Eur J Pediatr. 2025 May 31;184(6):380. doi: 10.1007/s00431-025-06224-3.
The association between pediatric traumatic brain injury (pTBI) and post-traumatic psychotic syndromes remains understudied subject. The objective of this study was to evaluate the association between pTBI and subsequent psychotic syndrome incidence in Finland. A nationwide retrospective cohort study in Finland from 1998 to 2018 included 71,969 pediatric (< 18 years) TBI patients and 64,856 references with distal extremity fractures. Our primary outcome was psychotic syndrome occurrence post-pTBI, analyzed via Kaplan-Meier (KM) survival and multivariable Cox regression with 95% confidence intervals (CI).. KM analyses demonstrated consistently elevated rates in pediatric TBI (pTBI), particularly notable 10 years post-trauma. Beyond the initial year, cumulative incidence was 0.04% in pTBI and 0.02% in the reference group. Cox regression revealed increased long-term psychotic syndrome risk in pTBI compared to the reference. Up to 10 years of follow-up, the hazard ratio (HR) was 1.34 (95% CI: 1.16-1.55). Notably, among females, pTBI exhibited higher cumulative rates than the reference group. Post the first year, cumulative incidence was 0.06% (pTBI) versus 0.03% (reference) for females. Following 3 years, the HR for pTBI females was 2.00 (95% CI: 1.24-3.23), decreasing to 1.08 (95% CI: 0.90-1.30) from 3 to 20 years.
These findings suggest that the risk of psychotic syndromes remains slightly elevated up to 10 years following pTBI.
• The association between pTBI and post-traumatic psychotic syndromes is relatively understudied. Existing literature mainly focuses on schizophrenia.
• This nationwide study found an association between pTBI and an increased risk of post-traumatic psychotic syndromes, particularly within the first 10 years after injury. Notably, female patients faced a higher risk.
儿童创伤性脑损伤（pTBI）与创伤后精神病综合征之间的关联仍是一个研究不足的课题。本研究的目的是评估芬兰pTBI与随后发生精神病综合征的发生率之间的关联。一项1998年至2018年在芬兰进行的全国性回顾性队列研究纳入了71969名儿科（<18岁）创伤性脑损伤患者和64856名远端肢体骨折的对照者。我们的主要结局是pTBI后发生的精神病综合征，通过Kaplan-Meier（KM）生存分析和95%置信区间（CI）的多变量Cox回归进行分析。KM分析表明，儿科创伤性脑损伤（pTBI）的发生率持续升高，在创伤后10年尤为显著。在最初一年之后，pTBI的累积发病率为0.04%，对照组为0.02%。Cox回归显示，与对照组相比，pTBI发生长期精神病综合征的风险增加。长达10年的随访中，风险比（HR）为1.34（95%CI：1.16-1.55）。值得注意的是，在女性中，pTBI的累积发病率高于对照组。在第一年之后，女性的累积发病率为0.06%（pTBI）对0.03%（对照组）。3年后，pTBI女性的HR为2.00（95%CI：1.24-3.23），从3年到20年降至1.08（95%CI：0.90-1.30）。
这些发现表明，pTBI后长达10年，精神病综合征的风险仍略有升高。
• pTBI与创伤后精神病综合征之间的关联研究相对较少。现有文献主要关注精神分裂症。
• 这项全国性研究发现pTBI与创伤后精神病综合征风险增加之间存在关联，尤其是在受伤后的头10年内。值得注意的是，女性患者面临的风险更高。
