儿童脑外伤致残疾结局的前瞻性队列研究

Traumatic brain injury (TBI) is the leading cause of death and disability in children and adolescent. Studies about the physical and functional disability outcome after pediatric traumatic brain injury and outcome measures have not been reported in China. We propose to conduct a prospective cohort study by using Ten Questions (TQ) that is a screening tool for children with disability, combined with Pediatric Quality of Life Inventory (PedsQL) and Child and Adolescent Scale of Participation (CASP) to assess the disability outcomes after trauma in selected children with TBI based on the results of the reliability and validity test for these three measures mentioned above. This study is undertaken to examine the level of disability including measures related to physical functioning, sensation, cognition, language, academics, social role participation, health-related quality of life, and daily life skills for children after TBI.A baseline survey is administered within 1 month after injury, and follow-up surveys are conducted 3,12,and 24 months after the date of the index injury. In this study, we seek to determine the extent of disability in all areas of functioning for children across the spectrum of severity and injury site, and to describe the time course of disability over the 24 months after injury. We also explore the disability risk factors in order to identify the children with increased risk of occurrence of disability after traumatic brain injury, and evaluate the validity for the outcome measures TQ, PedsQL and CASP. Findings from this study can provide the basic data about disability outcome and need of rehabilitation for children with traumatic brain injury, and can be used to build the basis for evaluation of disability outcome and the foundation of outcome evaluation system for pediatric traumatic brain injury in China. Also, the results of our study can provide the scientific evidence for disability prevention and treatment for traumatic brain injury in children.

脑外伤是导致儿童死亡与残疾的首位原因。我国目前尚无脑外伤儿童身体和功能残疾结局的系统研究及残疾结局评估工具。课题组在前期完成儿童生存质量测定量表、儿童青少年参与量表和残疾儿童十个问题量表信效度检验的基础上，采用前瞻性队列研究的方法，运用上述工具量表对入选脑外伤儿童的身体、情感、认知、言语、社会和学校表现、社会角色参与、健康相关生活质量、日常活动功能等进行全面评估。于伤后1个月内完成脑外伤儿童受伤前身体和功能状态的基线评定，并于伤后3、12和24个月进行三次随访评估，研究不同程度和不同损伤部位脑外伤儿童伤后2年的残疾结局及残疾随时间变化的趋势，探索脑外伤儿童发生残疾的高危因素，评价上述工具量表对我国脑外伤儿童残疾评估的适用情况。研究可提供我国脑外伤儿童残疾和康复需求的基础数据，为我国儿童脑外伤身体和功能残疾结局的系统评估和结局评估指标体系的建立奠定基础，并为脑外伤儿童残疾的防治提供科学依据。

脑外伤是全球重要的公共卫生问题，是导致儿童死亡与残疾的首位原因。在我国儿童脑外伤领域目前仍存在很多问题亟待研究解决，开展儿童脑外伤导致残疾结局的研究、危险因素研究以及评价工具的研究将会为儿童脑外伤的疾病负担提供基础信息，并为临床诊断、评价预后提供最佳证据。本研究采用前瞻性队列研究的方法，运用目前国际公认的、信效度高的评估工具对入选的脑外伤儿童的身体、健康相关生活质量和社会角色参与等功能进行系统评估，获得我国脑外伤儿童残疾和康复需求的基本信息。结果显示PedsQL量表、CASP量表总α系数和各维度的α系数均在0.7以上，各条目与各维度均存在相关性，尤其以各条目与其所属维度相关性最强，与其他方面相对弱，各条目与量表总分均有较高的相关性，表明两种量表具有良好的信效度；对TQ筛查结果与医生评定结果进行一致性检验，kappa一致性系数为0.924，结果显示TQ具有很高的灵敏度。研究结果表明PedsQL、CASP和TQ量表可用于我国脑外伤儿童的残疾结局评估。不同严重程度、不同损伤部位脑外伤的残疾率有显著差异。脑外伤轻度Ⅲ型、中度及重度患者伤后3个月的PedsQL评分均低于基线水平，而12个月评分较3个月略有增高或持平但仍低于基线水平，且差异均有统计学意义；以四肢损伤组作参考，在校正儿童年龄、性别、保险状况和家庭收入等的条件下，轻度脑外伤Ⅱ患者PedsQL评分在12月时仍低于基线水平，有统计学差异；轻度脑外伤Ⅱ、Ⅲ型和中重度脑外伤患者在伤后3个月随访CASP评分值低于基线水平，而12个月评分较3个月时略有增高但仍低于基线水平，且差异有统计学意义；以四肢损伤组作参考，在校正儿童年龄、性别、保险状况和家庭收入等的条件下，轻度脑外伤Ⅱ、Ⅲ型患者CASP评分在12月时仍低于基线水平，有统计学差异。影响脑外伤儿童残疾结局的因素有母亲职业、父母关系、保险模式、头部最高AIS评分、康复治疗、PedsQL和PSC的基线得分等。基线PedsQL得分越低、脑外伤严重程度越高、基线PSC得分越高和需要康复治疗者的残疾风险更高。