Abstract：
Protective factors, including psychological resilience, cognitive reserve, and brain reserve, may be positively associated with recovery after pediatric mild traumatic brain injury (mTBI) but are yet to be studied concurrently. We sought to examine these factors as moderators of post-concussive symptoms (PCS) in pediatric mTBI compared with mild orthopedic injury (OI). Participants included 967 children (633 mTBI, 334 OI) aged 8-16.99 years, recruited from 5 Canadian pediatric emergency departments as part of a prospective longitudinal cohort study. At 10 days post-injury, psychological resilience was measured using the Connor-Davidson Resilience Scale and brain reserve was measured using total brain volume derived from structural magnetic resonance imaging. Cognitive reserve was measured at 3 months post-injury using IQ scores from the Wechsler Abbreviated Scale of Intelligence-Second Edition. Cognitive and somatic PCS were measured using child and parent ratings on the Health and Behavior Inventory, completed weekly for 3 months and biweekly to 6 months. Analyses involved generalized least-squares regression models using restricted cubic splines. Covariates included age at injury, sex, racialized identity, material and social deprivation, pre-injury migraine and concussion history, and retrospective pre-injury PCS. Psychological resilience moderated group differences in parent-reported PCS. At 30 days post-injury, estimated group differences in parent-reported cognitive and somatic PCS (mTBI > OI) were larger at higher (75th percentile) resilience scores (Est = 2.25 [0.87, 3.64] and Est = 2.38 [1.76, 3.00], respectively) than at lower (25th percentile) resilience scores (Est = 1.44 [0.01, 2.86] and Est = 2.08 [1.45, 2.71], respectively). Resilience did not moderate group differences in child-reported PCS but was negatively associated with child-reported PCS in both groups (ps ≤ 0.001). Brain reserve (i.e., total brain volume [TBV]) also moderated group differences, but only for parent-reported somatic PCS (p = 0.018). Group difference (mTBI > OI) at 30 days was larger at smaller (25th percentile) TBV (Est = 2.78 [2.17, 3.38]) than at larger (75th percentile) TBV (Est = 1.95 [1.31, 2.59]). TBV was not associated with parent-reported cognitive PCS or child-reported PCS. IQ did not moderate PCS in either group but had a significant non-linear association in both groups with child-reported somatic PCS (p = 0.018) and parent-reported PCS (p < 0.001), with higher PCS scores at both lower and higher IQs. These findings suggest that higher resilience predicts fewer PCS, but less strongly after mTBI than OI; greater brain reserve may reduce the effect of mTBI on somatic PCS; and cognitive reserve has an unexpected curvilinear association with PCS across injury types. The results highlight the importance of protective factors as predictors of recovery and potential targets for intervention following pediatric mTBI.
摘要：
保护因素,包括心理弹性，认知储备,和大脑储备，可能与小儿轻度创伤性脑损伤（mTBI）后的恢复呈正相关，但尚未同时进行研究。与轻度骨科损伤（OI）相比，我们试图研究这些因素作为小儿mTBI脑震荡后症状（PCS）的调节剂。参与者包括967名儿童(633mTBI，334OI）年龄在8-16.99岁之间，作为前瞻性纵向队列研究的一部分，从加拿大5个儿科急诊科招募。受伤后10天,使用Connor-Davidson弹性量表(CD-RISC)测量心理弹性,并使用来自结构磁共振成像的总脑容量(TBV)测量脑储备.认知储备在受伤后3个月使用韦氏简明智力量表第二版的智商得分进行测量。使用儿童和父母对健康和行为量表的评分来测量认知和躯体PCS，每周完成3个月，每两周到6个月。分析涉及使用受限三次样条的广义最小二乘回归模型。协变量包括受伤时的年龄，性别,种族身份，物质和社会剥夺，伤前偏头痛和脑震荡史，和回顾性伤前PCS。心理弹性调节了父母报告的PCS的群体差异。受伤后30天,父母报告的认知和躯体PCS（mTBI>OI）的估计组差异在较高（第75百分位数）的弹性评分（Est=2.25[0.87，3.64]和Est=2.38[1.76，3.00]，分别)比在较低(第25百分位数)弹性分数(Est=1.44[0.01，2.86]和Est=2.08[1.45，2.71]，分别)。在儿童报告的PCS中，弹性并没有减轻组间差异，但在两组中与儿童报告的PCS呈负相关（ps<.001）。大脑储备(即，TBV)也缓和了群体差异，但仅适用于父母报告的体细胞PCS（p=0.018）。30天的组差异(mTBI>OI)在较小(第25百分位数)TBV(Est=2.78[2.17,3.38])时比在较大(第75百分位数)TBV(Est=1.95[1.31,2.59])时大。TBV与父母报告的认知PCS或儿童报告的PCS无关。两组中的智商均未降低PCS，但两组均与儿童报告的躯体PCS（p=.018）和父母报告的PCS（p<.001）具有显着的非线性关联，在较低和较高的智商下均具有较高的PCS分数。这些发现表明，更高的弹性预测更少的PCS，但mTBI后不如OI强；更大的大脑储备可能会降低mTBI对躯体PCS的影响；认知储备与不同损伤类型的PCS有意想不到的曲线关联。结果强调了保护因素作为小儿mTBI后恢复的预测因子和干预的潜在目标的重要性。
