Koe S, Price B, May S, Kyne L, Keenan P, McKay M, Nicholson A J
Children's University Hospital, Temple Street, Dublin 1.
Ir Med J. 2010 Apr;103(4):102-5.
Abusive head trauma (AHT) is the leading cause of death from traumatic brain injury in under 2 year olds. AHT presents with acute encephalopathy, subdural hemorrhages and retinal hemorrhages occurring in the context of an inappropriate or inconsistent history. We retrospectively analyzed, over a 10 year period, admissions and transfers to our hospital with suspected AHT to assess patterns of presentation, presenting symptoms, investigations, subsequent confirmation, social work input and both neurological and social outcomes. We analyzed all suspected AHT infants and children looking for the time of presentation, presenting symptoms, caregivers concerns prior to presentation, a family profile including stressors, investigations (in particular neuroradiology and ophthalmology assessments), treatment in hospital, length of stay in hospital, social work involvement, subsequent discharge, neurological outcome and subsequent social work follow up. Data was collected from the hospital HIPE system, RIS (radiology reports system) and records from the social work department from a period October 1998 to January 2009 inclusive. Of 22 patients with confirmed AHT, ages seizures and irritability followed by vomiting, poor feeding, a bulging fontanelle and lethargy. The father was the sole minder in 5 cases. There was a delayed history in 4 cases. One had multiple visits to his GP. All cases had subdural hemorrhages proven by either CT or MRI scans and retinal hemorrhages diagnosed by ophthalmology. One infant presented with a torn frenulum. Four had suspicious bruising. All had normal coagulation profiles, skeletal surveys and extensive metabolic tests. Hospital stays ranged from 1 to 124 days (the median was 28 days and mean 33 days). Ten (45%) infants required ventilatory support. Sixteen infants had social work involvement within 4 days of admission (7 of these were interviewed immediately). Outcomes after case conferences were that 6 returned home with parents, 9 were placed in foster care. Four parents (18%) admitted to shakng their infants. There was 1 death. Thirteen (60%) were normal on follow up. Two had ADHD. Two had language delay. Two had motor delay. One criminal prosecution has ensued as yet Children with suspected AHT should undergo appropriate investigations which should include brain imaging, ophthalmic examination, skeletal survey and blood investigations. Early social work assessment is a priority as part of the multidisciplinary approach. A prospective national study of AHT is required.
虐待性头部外伤（AHT）是2岁以下儿童因创伤性脑损伤致死的主要原因。AHT表现为急性脑病、硬膜下出血和视网膜出血，且病史不恰当或前后矛盾。我们回顾性分析了10年间因疑似AHT入院及转至我院的病例，以评估其临床表现模式、症状、检查、后续确诊情况、社会工作介入情况以及神经和社会方面的结局。我们分析了所有疑似AHT的婴幼儿，查找其就诊时间、症状、就诊前照料者的担忧、包括压力源在内的家庭情况、检查（尤其是神经放射学和眼科评估）、住院治疗情况、住院时长、社会工作介入情况、随后的出院情况、神经结局以及后续的社会工作随访。数据收集自1998年10月至2009年1月期间医院的HIPE系统、RIS（放射学报告系统）以及社会工作部门的记录。在确诊为AHT的22例患者中，症状依次为癫痫发作、易激惹，随后是呕吐、喂养困难、囟门隆起和嗜睡。5例患者的唯一照料者为父亲。4例有延迟的病史。1例多次就诊于全科医生。所有病例均经CT或MRI扫描证实有硬膜下出血，眼科诊断有视网膜出血。1例婴儿出现系带撕裂。4例有可疑瘀伤。所有患者凝血指标、骨骼检查和广泛的代谢检查均正常。住院时长从1天至124天不等（中位数为28天，平均为33天）。10例（45%）婴儿需要通气支持。16例婴儿在入院后4天内有社会工作介入（其中7例立即接受了访谈）。病例讨论后的结局为，6例与父母一同回家，9例被安置在寄养家庭。4名家长（18%）承认摇晃过婴儿。有1例死亡。13例（60%）随访时情况正常。2例患有注意力缺陷多动障碍（ADHD）。2例有语言发育迟缓。2例有运动发育迟缓。目前已有1例刑事诉讼。疑似AHT的儿童应接受包括脑成像、眼科检查、骨骼检查和血液检查在内的适当检查。作为多学科方法的一部分，早期社会工作评估是优先事项。需要对AHT进行一项前瞻性全国性研究。
