PDF(Pubmed)
Abstract：
Pediatric mild traumatic brain injury (pmTBI) has received increased public attention over the past decade, especially for children who experience persistent post-concussive symptoms (PCS). Common methods for obtaining pediatric PCS rely on both self- and parental report, exhibit moderate test-retest reliability, and variable child-parent agreement, and may yield high false positives. The current study investigated the impact of age and biological sex on PCS reporting (Post-Concussion Symptom Inventory) in patients with pmTBI (n = 286) at retrospective, 1 week, 4 months, and 1 year post-injury time points, as well as reported symptoms in healthy controls (HC; n = 218) at equivalent assessment times. HC and their parents reported higher PCS for their retrospective rating relative to the other three other study visits. Child-parent agreement was highest for female adolescents, but only approached acceptable ranges (≥ 0.75) immediately post-injury. Poor-to-fair child/parental agreement was observed for most other study visits for pmTBI and at all visits for HC. Parents rated female adolescents as being more symptomatic than their male counterparts in spite of small (pmTBI) or no (HC) sex-related differences in self-reported ratings, suggestive of a potential cultural bias in parental ratings. Test-retest reliability for self-report was typically below acceptable ranges for both pmTBI and HC groups, with reliability decreasing for HC and increasing for pmTBI as a function of time between visits. Parental test-retest reliability was higher for females. Although continued research is needed, current results support the use of child self-report over parental ratings for estimating PCS burden. Results also highlight the perils of relying on symptom self-report for diagnostic and prognostic purposes.
摘要：
在过去的十年中，小儿轻度创伤性脑损伤（pmTBI）受到了越来越多的公众关注，特别是对于经历持续脑震荡后症状（PCS）的儿童。获得儿科PCS的常见方法依赖于自我和父母报告，表现出中等的重测可靠性，可变的子母协议，可能会产生很高的误报。本研究回顾性调查了年龄和生物学性别对pmTBI患者（N=286）的PCS报告（脑震荡后症状清单）的影响，一个星期,受伤后四个月和一年的时间点，以及健康对照（HC；N=218）在相同的评估时间。健康对照（HC）及其父母报告的PCS相对于其他三个研究访问较高。女青少年的儿童父母协议最高，但仅在受伤后立即接近可接受范围(≥0.75)。在pmTBI的大多数其他研究访问和HC的所有访问中，观察到儿童/父母之间的协议较差。尽管自我报告的评分与性别相关的差异很小（pmTBI）或没有（HC），但父母认为女性青少年比男性青少年更有症状。暗示父母评级中潜在的文化偏见。自我报告的重测可靠性通常低于pmTBI和HC组的可接受范围，随着两次访问之间时间的变化，HC的可靠性降低，pmTBI的可靠性增加。女性的父母重测信度较高。虽然需要继续研究，目前的结果支持使用儿童自我报告而不是父母评分来估计PCS负担。结果还强调了依赖症状自我报告进行诊断和预后目的的危险。
