Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
J Crit Care. 2010 Mar;25(1):175.e7-12. doi: 10.1016/j.jcrc.2009.06.011. Epub 2009 Aug 13.
The aim of this study was to review the patterns of severe childhood injuries and poisoning necessitating pediatric intensive care in a regional trauma center.
We reviewed discharge data of all children who were hospitalized for severe injuries and poisoning at the pediatric intensive care unit of a teaching hospital between October 2002 and December 2008.
There were 86 patients (males/females, 2:1). Road traffic injuries (n = 19), falls (n = 17), and scalds (n = 13) were the 3 leading categories and accounted for 57% of these pediatric intensive care unit admissions. Injuries more commonly occurred indoor (63%), and victims of indoor accidents were younger (median age, 2.6 vs 8.4 years; P < .0001), with scalds, poisoning, and foreign body aspiration being predominant, whereas road traffic accidents predominated in outdoor accidents. As a risk factor, premorbid neurodevelopmental conditions such as mental retardation, convulsion disorder, or cerebral palsy were only present in indoor accidents. Children in outdoor injuries were generally healthy. Both groups were associated with significant morbidity (mechanical ventilation in 60%, inotrope use in 20%, anticonvulsants in 24%, and neurological/neurosurgical supports in 49%). Comparing the 3 most common categories of patients, there were significant differences in the median age, requirement of neurological/neurosurgical supports, and median hospital stay. Although not requiring neurological/neurosurgical supports, scalds injuries involved the youngest age group and required the longest hospital stay.
The causes of severe childhood injuries are heterogeneous. Cardiopulmonary or neurological/neurosurgical supports are often required. These injuries more commonly occur indoor and involve toddlers with underlying neurodevelopmental conditions. These findings have important implications and serve to heighten public awareness especially on home safety measures in the prevention of childhood accidents.
本研究旨在回顾区域性创伤中心小儿重症监护病房收治的严重儿童损伤和中毒的模式。
我们回顾了 2002 年 10 月至 2008 年 12 月期间在教学医院小儿重症监护病房住院的所有严重损伤和中毒儿童的出院数据。
共有 86 名患者（男/女，2:1）。道路交通伤（n=19）、跌倒（n=17）和烫伤（n=13）是前 3 位主要类别，占这些小儿重症监护病房入院的 57%。损伤更常见于室内（63%），室内事故受害者年龄更小（中位数年龄，2.6 岁与 8.4 岁；P<.0001），以烫伤、中毒和异物吸入为主，而道路交通伤则以户外事故为主。作为一个危险因素，精神发育迟滞、癫痫发作障碍或脑瘫等先天神经发育障碍仅存在于室内事故中。户外受伤的儿童通常身体健康。两组均与显著发病率相关（60%机械通气、20%使用儿茶酚胺、24%使用抗惊厥药和 49%神经/神经外科支持）。比较 3 种最常见的患者类别，中位数年龄、需要神经/神经外科支持和中位数住院时间存在显著差异。尽管不需要神经/神经外科支持，但烫伤损伤涉及最年轻的年龄组，需要最长的住院时间。
严重儿童损伤的原因是多种多样的。心肺或神经/神经外科支持通常是必要的。这些损伤更常见于室内，涉及有先天神经发育障碍的幼儿。这些发现具有重要意义，有助于提高公众意识，特别是在家中采取安全措施预防儿童事故。
