3 个月以下儿童的轻微头部创伤和临床重要脑外伤的临床预测因素。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Pediatric emergency care Pub Date : 2024-11-19 DOI:10.1097/PEC.0000000000003295

Marco Vajna de Pava, Martina Samperi, Ilia Bresesti, Lorenza Bertù, Anna Maria Plebani, Massimo Agosti

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引用次数: 0

摘要

目的：主要研究已确定了儿童头部外伤后使用计算机断层扫描的临床规则。与年龄较大的儿童相比，3 个月以下的婴儿发生脑损伤的风险较高，同时受到辐射损伤的风险也较高。因此，临床决策规则最好能更适合这一患者群体。本研究的目的是比较 3 个月以下儿童和 3 至 24 个月儿童的脑损伤发生率，并评估前一组儿童的临床重要创伤性脑损伤（ciTBIs）（导致死亡、神经外科干预、长时间插管或住院 2 天或以上的脑损伤）的预测因素：方法：回顾性审查了三年内因轻微头部外伤在一个急诊科接受评估的 24 个月以下儿童的记录。比较了3个月以下和3个月以上儿童的脑损伤发生率。对年龄较小的儿童中与严重损伤相关的变量进行了评估：研究包括 744 名患者，其中 86 人（11.6%）的年龄在 0 至 90 天之间，658 人（88.4%）的年龄在 91 至 730 天之间。与老年组相比，我们发现幼儿组的脑外伤（14.0% 对 4.1%，P = 0.0008）和 ciTBI（8.1% 对 1.5%，P = 0.002）发生率更高。在年轻组中，心率（几率比[OR]，12.3；95% 置信区间[CI]，2.4-62.4）、非额部头皮血肿（OR，9.2；95% CI，1.8-46.1）、严重机制（OR，8.1% vs 1.5%，P = 0.0008）和 ciTBI（8.1% vs 1.5%，P = 0.002）与 ciTBI 有明显相关性。1）、严重机制（OR，5.6；95% CI，1.1-27.6）、血肿存在（OR，6.1；95% CI，1.2-30.0）、血肿大小大于 3 厘米（OR，23.8；95% CI，4.2-135.6）和血肿位置（OR，9.2；95% CI，1.8-46.1）：结论：小于 3 个月的轻微头部外伤患儿是一个相关人群。结论：小于 3 个月的儿童是轻微头部创伤后的相关人群，现有的临床预测指标与该年龄组的 ciTBIs 有很好的相关性。

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Minor Head Trauma in Children Younger Than 3 Months and Clinical Predictors of Clinically Important Traumatic Brain Injuries.

Objectives: Major studies have defined clinical rules to regulate the use of computed tomography in children after head trauma. Infants younger than 3 months are considered at higher risk of brain injuries than older children and at the same time at higher risk of radiation-induced damage. Hence, it would be desirable to have clinical decision rules more adapted to this subset of patients. The objectives of this study are to compare the rate of brain injuries in children younger than 3 months or 3 to 24 months and to assess predictors of clinically important traumatic brain injuries (ciTBIs) (the ones causing death, neurosurgical intervention, long intubation, or hospitalization for 2 days or more) in the former group.

Methods: Records of children younger than 24 months evaluated in a single emergency department for minor head trauma during a 3 years period were retrospectively reviewed. The rates of brain injuries were compared in children younger or older than 3 months. Variables associated with severe lesions were assessed in younger children.

Results: The study included 744 patients, 86 (11.6%) aged 0 to 90 days and 658 (88.4%) aged 91 to 730 days. Within the young group, we found higher rates of traumatic brain injuries (14.0% vs 4.1%, P = 0.0008) and ciTBI (8.1% vs 1.5%, P = 0.002) compared with the old group. A significant correlation with ciTBI in the young group was observed for heart rate (odds ratio [OR], 12.3; 95% confidence interval [CI], 2.4-62.4), nonfrontal scalp hematoma (OR, 9.2; 95% CI, 1.8-46.1), severe mechanism (OR, 5.6; 95% CI, 1.1-27.6), presence of hematoma (OR, 6.1; 95% CI, 1.2-30.0), hematoma size >3 cm (OR, 23.8; 95% CI, 4.2-135.6), and hematoma location (OR, 9.2; 95% CI, 1.8-46.1).

Conclusions: Children younger than 3 months presenting after minor head trauma constitute a relevant population. Available clinical predictors well correlate with ciTBIs in this age group.

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来源期刊

Pediatric emergency care 医学-急救医学

CiteScore

2.40

自引率

14.30%

发文量

577

审稿时长

3-6 weeks

期刊介绍： Pediatric Emergency Care®, features clinically relevant original articles with an EM perspective on the care of acutely ill or injured children and adolescents. The journal is aimed at both the pediatrician who wants to know more about treating and being compensated for minor emergency cases and the emergency physicians who must treat children or adolescents in more than one case in there.