神经心理学家对美国疾病控制与预防中心儿童轻度创伤性脑损伤诊断与治疗指南的评论

Kelly Sarmiento, G. Gioia, Michael W. Kirkwood, S. Wade, K. Yeates
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引用次数: 8

摘要

摘要目的:2018年,美国疾病预防控制中心(CDC)发布了儿童轻度创伤性脑损伤(mTBI)诊断和治疗循证指南。这篇评论总结了CDC小儿mTBI指南中与神经心理学家最相关的关键建议,并讨论了在指南的未来迭代中应该得到关注的研究差距和主题。方法:我们描述了用于制定指南的方法,其中包括一个全面的系统评价。我们还提炼并提出了指南中反映的关键实践策略。结果:为了优化儿童mTBI患者的护理,神经心理学家应该:使用经过验证的、与年龄相适应的症状量表,评估长期康复的循证危险因素,为患者提供根据其症状定制的恢复活动指导,并建议患者在短暂休息后逐渐恢复非运动活动。指南的未来修订应包括对精神和心理困难患者护理的审查和指导,以及可能使用影像学来评估持续症状的患者。扩大对女孩、8岁及以下儿童mTBI的研究,以及对儿童mTBI的有效治疗,将有助于为护理实践提供信息。结论:CDC儿科mTBI指南中的建议强调了神经心理学家采取行动改善年轻mTBI患者护理和推进该领域研究的多重机会。有多种资源和工具可用于支持这些建议在临床实践中的实施。
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A commentary for neuropsychologists on CDC’s guideline on the diagnosis and management of mild traumatic brain injury among children
Abstract Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline. Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline. Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices. Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.
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