Paret G, Tirosh R, Lotan D, Stein M, Ben-Abraham R, Vardi A, Harel R, Barzilay Z
Pediatric Intensive Care Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
J Accid Emerg Med. 1999 May;16(3):186-8. doi: 10.1136/emj.16.3.186.
Falls are the foremost reason for non-fatal injuries and are second only to motor vehicle accidents in causing accidental death. The purpose of this study was to identify the clinical and metabolic predictors of the outcome of head injury caused by falls from a height. Medical records of 61 children who had been admitted to the paediatric intensive care unit from 1990 to 1993 after falling from a height were reviewed retrospectively. Outcomes were categorised as good, moderate, severe, and poor. Glasgow coma scores, pupillary responses, brain oedema, and midline shift are significantly associated with poor outcome (p < 0.05). Metabolic markers associated with poor outcome included hyperglycaemia and hypokalaemia. Children with a poor outcome had, at admission, significantly higher glucose concentrations compared with children with good outcomes (mean SD): 20.0 (7.1) v 9.31 (4.0) mmol/l, p < 0.01), and lower potassium concentrations compared with children with good, moderate, and severe outcomes (mean (SD): 2.8 (0.4) v 3.7 (0.4) mmol/l, p < 0.001, 3.5 (0.3) mmol/l, p < 0.01, and 3.41 (0.3) mmol/l, p < 0.05, respectively). These findings allow for an early allocation of effort and resources to children injured from such falls.
跌倒是非致命伤害的首要原因，在导致意外死亡方面仅次于机动车事故。本研究的目的是确定高处坠落所致头部损伤结局的临床和代谢预测因素。回顾性分析了1990年至1993年期间因高处坠落入住儿科重症监护病房的61名儿童的病历。结局分为良好、中等、严重和差。格拉斯哥昏迷评分、瞳孔反应、脑水肿和中线移位与不良结局显著相关（p<0.05）。与不良结局相关的代谢指标包括高血糖和低钾血症。结局差的儿童在入院时的血糖浓度显著高于结局良好的儿童（均数±标准差）：20.0（7.1）vs 9.31（4.0）mmol/L，p<0.01），与结局良好、中等和严重的儿童相比，钾浓度更低（均数（标准差）：2.8（0.4）vs 3.7（0.4）mmol/L，p<0.001；3.5（0.3）mmol/L，p<0.01；3.41（0.3）mmol/L，p<0.05）。这些发现有助于早期为因此类坠落受伤的儿童分配精力和资源。
