Abbate B, Donati P, Cagnoni G
Ospedale Anna Meyer, Firenze.
Minerva Pediatr. 2000 Nov;52(11):623-8.
The authors present their personal experience of 3715 cases of head injury in pediatric patients, occurring during the last three years (1997-1999), admitted to the Emergency ward at the "Anna Meyer" children's hospital in Florence.
A prospective study was made, starting from the evaluation made by the paediatric surgeon and following the subsequent diagnostic and clinical course. Depending on the severity of injury, this took the form of immediate discharge with a written sheet of instructions, "short observation" (up to 12 hours) in an Emergency ward and/or admission to neurosurgery or general medicine or to intensive care. The authors also analyse the diagnostic and instrumental tests carried out at the various stages (cranial X-ray, direct cranial CT, EEG) and the specialist consultations required (neurosurgery, neurology, paediatrics, resuscitation). Data for injured children transferred from other hospitals for neurosurgery were excluded from the study which only included patients examined primarily at our hospital. If admitted for more than 48 hours, a neurosurgical outpatient check-up was programmed one week later. In more severe cases, patients were admitted to day hospital between six months and one year later.
Injuries were minor in 91% of cases and the age of patients ranged between 5 days and 14 years; moreover, 60% of the patients observed were male. Only 1.5% of cases seen in Emergency were admitted to hospital and 8.4% of all head injuries, with a total stay of between 1 and 6 days. There were 4 deaths in severely polytraumatised patients. There was only one case of firearm injury which was not fatal. Head X-rays were performed in 13.4% of patients showing evidence of fracture in 19.1% of cases. Direct cranial CT was performed in 10.2% of cases with pathological findings in 23.9% of cases. Neurosurgery was performed in one of the 5.9% patients admitted to hospital. The late sequelae to head injury included one case of epilepsy that occurred 7 months after injury.
Anamnesis showed that the most frequent reason leading to head injury was lack of adult supervision and that the majority of severe injuries were caused by road accidents, both as pedestrians and as passengers. Lastly, the authors emphasise the importance of recognising and correctly treating so-called secondary cerebral damage, which has a non-immediate onset but is potentially severe, and identifying the risk factors for head injury in order to reduce the incidence and severity.
作者介绍了过去三年（1997 - 1999年）在佛罗伦萨“安娜·迈耶”儿童医院急诊病房收治的3715例儿科头部受伤患者的个人经验。
进行了一项前瞻性研究，从儿科外科医生的评估开始，随后跟踪诊断和临床过程。根据损伤的严重程度，采取的形式包括立即出院并附有书面指导说明、在急诊病房“短期观察”（长达12小时）和/或入住神经外科、普通内科或重症监护病房。作者还分析了在各个阶段进行的诊断和检查（头颅X光、直接头颅CT、脑电图）以及所需的专科会诊（神经外科、神经内科、儿科、复苏）。从其他医院转来进行神经外科治疗的受伤儿童的数据被排除在研究之外，该研究仅包括主要在我院接受检查的患者。如果住院超过48小时，计划在一周后进行神经外科门诊检查。在更严重的情况下，患者在6个月至1年后入住日间医院。
91%的病例损伤较轻，患者年龄在5天至14岁之间；此外，观察到的患者中60%为男性。在急诊中见到的病例中只有1.5%住院，所有头部受伤病例中有8.4%住院，总住院时间为1至6天。严重多发伤患者中有4例死亡。只有1例火器伤，未致命。13.4%的患者进行了头颅X光检查，其中19.1%的病例显示有骨折迹象。10.2%的病例进行了直接头颅CT检查，23.9%的病例有病理结果。住院的5.9%患者中有1例进行了神经外科手术。头部损伤的晚期后遗症包括1例伤后7个月发生的癫痫。
病史显示，导致头部受伤最常见的原因是缺乏成人监管，大多数严重损伤是由道路交通事故造成的，无论是行人还是乘客。最后，作者强调了识别和正确治疗所谓的继发性脑损伤的重要性，这种损伤并非立即发作但可能很严重，以及识别头部受伤的危险因素以降低发病率和严重程度。
