Sugar N F, Taylor J A, Feldman K W
Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
Arch Pediatr Adolesc Med. 1999 Apr;153(4):399-403. doi: 10.1001/archpedi.153.4.399.
To determine the frequency and location of bruises in normal infants and toddlers, and to determine the relationship of age and developmental stage to bruising.
Cross-sectional survey.
Community primary care pediatric offices.
Children younger than 36 months attending well-child care visits.
Prospective data collection of demographics, developmental stage, and presence and location of bruises. Any medical condition that causes bruises as well as known or suspected abuse was also recorded. A chi2 test or Fisher exact test was used to determine the significance of differences.
Presence and location of bruises as related to age and developmental stage.
Bruises were found in 203 (20.9%) of 973 children who had no known medical cause for bruising and in whom abuse was not suspected. Only 2 (0.6%) of 366 children who were younger than 6 months and 8 (1.7%) of 473 children younger than 9 months had any bruises. Bruises were noted in only 11 (2.2%) of 511 children who were not yet walking with support (cruising). However, 17.8% of cruisers and 51.9% of walkers had bruises (P<.001). Mean bruise frequency ranged from 1.3 bruises per injured child among precruisers (range, 1-2 bruises) to 2.4 per injured child among walkers (range, 1-11). The most frequent site of bruises was over the anterior tibia and knee. Bruises on the forehead and upper leg were common among walkers, but bruises on the face and trunk were rare, and bruises on the hands and buttocks were not observed at any age. There were no differences in bruise frequency by sex. African American children were observed to have bruises much less frequently than white children (P<.007).
Bruises are rare in normal infants and precruisers and become common among cruisers and walkers. Bruises in infants younger than 9 months and who are not yet beginning to ambulate should lead to consideration of abuse or illness as causative. Bruises in toddlers that are located in atypical areas, such as the trunk, hands, or buttocks, should prompt similar concerns.
确定正常婴幼儿瘀伤的发生率及部位，并确定年龄和发育阶段与瘀伤的关系。
横断面调查。
社区初级保健儿科诊所。
参加健康儿童保健门诊的36个月以下儿童。
前瞻性收集人口统计学资料、发育阶段以及瘀伤的存在情况和部位。还记录了任何导致瘀伤的疾病以及已知或疑似虐待情况。采用卡方检验或Fisher精确检验来确定差异的显著性。
与年龄和发育阶段相关的瘀伤存在情况和部位。
在973名无已知医学原因导致瘀伤且未被怀疑有虐待行为的儿童中，有203名（20.9%）发现有瘀伤。在366名6个月以下儿童中，只有2名（0.6%）有瘀伤；在473名9个月以下儿童中，有8名（1.7%）有瘀伤。在511名尚不能在支撑下行走（扶走）的儿童中，只有11名（2.2%）有瘀伤。然而，在能扶走的儿童中有17.8%有瘀伤，在会走路的儿童中有51.9%有瘀伤（P<0.001）。平均瘀伤发生率从前扶走儿童中每个受伤儿童1.3处瘀伤（范围为1 - 2处瘀伤）到会走路儿童中每个受伤儿童2.4处瘀伤（范围为1 - 11处）。瘀伤最常见的部位是胫骨前部和膝盖。前额和大腿上部的瘀伤在会走路的儿童中很常见，但面部和躯干的瘀伤很少见，在任何年龄的儿童中均未观察到手部和臀部有瘀伤。瘀伤发生率在性别上无差异。观察发现非裔美国儿童瘀伤的发生率远低于白人儿童（P<0.007）。
瘀伤在正常婴儿和前扶走儿童中很少见，在能扶走和会走路的儿童中变得常见。9个月以下且尚未开始行走的婴儿出现瘀伤应考虑虐待或疾病为病因。幼儿在非典型部位（如躯干、手部或臀部）出现瘀伤应引起类似的关注。
