RESUMEN
OBJECTIVE: To investigate the effects of mild traumatic brain injury (mTBI) in children on symptom ratings of behavior problems across the first-year postinjury. SETTING: Emergency departments of 2 regional children's hospitals. PARTICIPANTS: Parents of 176 children with mTBI and 90 children with orthopedic injury aged 8 to 15 years. DESIGN: Group comparisons of postinjury parent and teacher ratings of child behavior problems controlling for background factors. MAIN MEASURES: Child Behavior Checklist and Teacher's Report Form. RESULTS: For younger but not older children in the sample, children with mTBI compared with children with orthopedic injury had higher postinjury ratings on the Child Behavior Checklist Total Behavior Problem scale (t264 = 3.34, P < .001) and higher rates of T-scores of 60 or more on this scale (odds ratio = 3.00; 95% confidence interval, 1.33-6.77; P = .008). For children with mTBI, hospitalization, motor vehicle accidents, loss of consciousness, and magnetic resonance imaging abnormality were associated with higher parent or teacher ratings. CONCLUSIONS: School-aged children with mTBI are at risk for persistent symptoms of behavior problems, especially if mTBI is more severe or occurs at a younger age. The findings justify monitoring of behavior long after injury and further research to identify risk factors for these symptoms and their association with clinical disorders.
Asunto(s)
Lesiones Encefálicas/psicología , Trastornos de la Conducta Infantil/etiología , Problema de Conducta/psicología , Heridas y Lesiones/psicología , Adolescente , Distribución por Edad , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/diagnóstico , Canadá/epidemiología , Niño , Trastornos de la Conducta Infantil/fisiopatología , Enfermedad Crónica , Estudios de Cohortes , Intervalos de Confianza , Femenino , Hospitales Pediátricos , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Imagen por Resonancia Magnética/métodos , Masculino , Ortopedia , Síndrome Posconmocional/complicaciones , Síndrome Posconmocional/diagnóstico , Síndrome Posconmocional/psicología , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Distribución por Sexo , Tomografía Computarizada por Rayos X , Heridas y Lesiones/complicaciones , Heridas y Lesiones/diagnósticoRESUMEN
Our objectives were to examine cognitive outcomes for extremely preterm/extremely low birth weight (EPT/ELBW, gestational age <28 weeks and/or birth weight <1000 g) children in kindergarten and the associations of these outcomes with neonatal factors, early childhood neurodevelopmental impairment, and socioeconomic status (SES). The sample comprised a hospital-based 2001-2003 birth cohort of 148 EPT/ELBW children (mean birth weight 818 g; mean gestational age 26 weeks) and a comparison group of 111 term-born normal birth weight (NBW) classmate controls. Controlling for background factors, the EPT/ELBW group had pervasive deficits relative to the NBW group on a comprehensive test battery, with rates of cognitive deficits that were 3 to 6 times higher in the EPT/ELBW group. Deficits on a measure of response inhibition were found in 48% versus 10%, odds ratio (95% confidence interval) = 7.32 (3.32, 16.16), p < .001. Deficits on measures of executive function and motor and perceptual-motor abilities were found even when controlling for acquired verbal knowledge. Neonatal risk factors, early neurodevelopmental impairment, and lower SES were associated with higher rates of deficits within the EPT/ELBW group. The findings document both global and selective cognitive deficits in EPT/ELBW children at school entry and justify efforts at early identification and intervention.