Keenan Heather T
Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
Am J Prev Med. 2008 Apr;34(4 Suppl):S120-5. doi: 10.1016/j.amepre.2007.11.001.
The article describes practical problems encountered in setting up and maintaining an active statewide surveillance system for a low-frequency but high-impact injury, inflicted traumatic brain injury (inflicted TBI). A system was designed to identify prospectively all children aged <2 years with a traumatic brain injury (TBI) admitted to any of the nine pediatric intensive care units (ICUs) in North Carolina in 2000 and 2001. Children who died prior to admission to hospital were identified from the records of the Office of the Chief Medical Examiner. The study design had strengths and weaknesses for ongoing surveillance. Strengths included a clear definition of a case, mechanisms to jury undecided cases, and a high level of quality control. Difficulties included appropriately addressing investigators' ethical and legal obligations in the study of child abuse, differing requirements of multiple institutional review boards (IRBs), and the time-intensive nature of the system. The described surveillance system produced high-quality data, but may not be practical for ongoing multi-year injury surveillance. Incorporation of inflicted TBI into an existing surveillance system, such as a trauma database, may be a feasible solution to many of the problems encountered.
本文描述了在建立和维持一个针对低频但高影响性损伤——外伤性脑损伤（创伤性脑损伤）的全州主动监测系统时遇到的实际问题。该系统旨在前瞻性地识别2000年和2001年在北卡罗来纳州9个儿科重症监护病房（ICU）中因创伤性脑损伤（TBI）入院的所有2岁以下儿童。入院前死亡的儿童从首席法医办公室的记录中识别。该研究设计对于持续监测有优点和缺点。优点包括病例定义明确、解决未决病例的机制以及高水平的质量控制。困难包括在虐待儿童研究中妥善处理调查人员的伦理和法律义务、多个机构审查委员会（IRB）的不同要求以及该系统的时间密集性。所描述的监测系统产生了高质量的数据，但对于持续多年的损伤监测可能不实用。将创伤性脑损伤纳入现有的监测系统，如创伤数据库，可能是解决所遇到的许多问题的可行办法。
