Fujiwara Takeo, Okuyama Makiko, Miyasaka Mikiko
Section of Behavioral Science, Department of Health Promotion and Research, National Institute of Public Health, Saitama, Japan.
Pediatrics. 2008 Oct;122(4):e841-7. doi: 10.1542/peds.2008-0387. Epub 2008 Sep 1.
Distinguishing abusive head trauma in young children from other diseases by symptoms is difficult in practice. Comparisons between abusive and nonabusive head trauma in young children in Japan, where computed tomography is widely and easily available, might contribute to identifying markers of abusive head trauma that differ from that in Western countries. The objective of this study was to compare the characteristics of abusive and nonabusive head trauma in young children in Japan.
A comparative case series study involving a retrospective medical chart and social work record review of children who were aged 0 to 2 years, visited the National Center for Child Health and Development (Tokyo, Japan) from March 1, 2002, to December 31, 2005, and underwent computed tomography scanning because of suspected intracranial injury was performed. Patients (N = 260) were identified and classified as having either abusive or nonabusive head trauma on the basis of the published definition. Demographic and perinatal characteristics, injury history, clinical presentation, and outcomes were compared by using chi2 and Fisher's exact tests.
Patients with abusive head trauma were significantly younger than patients with nonabusive head trauma and had a peak at approximately 2 to 4 and 7 to 9 months. Patients with abusive head trauma more likely presented no injury history by the caregiver, neurologic symptoms (unconsciousness, seizure, paralysis), subdural hemorrhage, and retinal hemorrhages. Although patients with abusive head trauma had severe clinical outcomes, only 32% of them were separated from the caregiver by social welfare services.
This study highlights the several clinical markers to detect abusive head trauma at a medical visit, including an absence of injury history, neurologic symptoms, subdural hemorrhage, and retinal hemorrhage. These markers can be used to detect abusive head trauma cases by physicians and social welfare workers to protect children from additional abuse.
在实际操作中，通过症状将幼儿虐待性头部创伤与其他疾病区分开来是困难的。在日本，计算机断层扫描广泛且容易获得，比较日本幼儿虐待性和非虐待性头部创伤可能有助于识别与西方国家不同的虐待性头部创伤标志物。本研究的目的是比较日本幼儿虐待性和非虐待性头部创伤的特征。
进行一项比较性病例系列研究，对2002年3月1日至2005年12月31日期间年龄在0至2岁、因疑似颅内损伤前往日本东京国立儿童健康与发展中心就诊并接受计算机断层扫描的儿童进行回顾性病历和社会工作记录审查。根据已发表的定义确定患者（N = 260），并将其分类为患有虐待性或非虐待性头部创伤。使用卡方检验和费舍尔精确检验比较人口统计学和围产期特征、损伤史、临床表现和结局。
虐待性头部创伤患者比非虐待性头部创伤患者明显年轻，发病高峰分别在大约2至4个月和7至9个月。虐待性头部创伤患者更有可能没有照顾者提供的损伤史、出现神经症状（意识丧失、癫痫发作、瘫痪）、硬膜下出血和视网膜出血。尽管虐待性头部创伤患者有严重的临床结局，但只有32%的患者被社会福利服务机构与照顾者分开。
本研究强调了在就诊时检测虐待性头部创伤时的几个临床标志物，包括无损伤史、神经症状、硬膜下出血和视网膜出血。这些标志物可用于医生和社会福利工作者检测虐待性头部创伤病例，以保护儿童免受进一步虐待。
