Zwingmann J, Schmal H, Mehlhorn A, Südkamp N P, Strohm P C
Department of Orthopaedic and Trauma Surgery, University of Freibury Medicial Center, Germany.
Acta Chir Orthop Traumatol Cech. 2010 Oct;77(5):365-70.
The effective initial treatment in the emergency room of polytraumatized children requires a sound knowledge of com- mon injury patterns, incidence, mortality, and consequences. The needed initial radiological imaging remains controversial and should be adapted to the expected injury pattern.
In this retrospective study, the injury patterns of 56 polytraumatized paediatric patients (age ≤ 16 years) in the period from December 2001 to May 2009 were evaluated. All children were initially diagnosed with a whole body CT scan. The cause of accident, the localization including the detailed diagnose, the lethality and the severity of the injuries were analyzed. The AIS (Abbreviated Injury Scale) and ISS (Injury Severity Score) were used to classify the severity of injuries in different body regions. Moreover the number and the kind of operation as a consequence of the initial made diagnoses were investigated.
The mean ISS was 30 ± 13 in 38 boys and 18 girls with a mean age of 10 years. The lethality was 13% and 4% in the first 24 hours. The most severe and most frequent injury was craniocerebral trauma in 89% with an AIS ≥ 3 in 80%. Surgical intervention of the head was done in 41%. Thorax injuries were found in 63% with 57% with an AIS ≥ 3 and in 11% a thoracic drainage was needed. Abdominal trauma was found in 34% (surgery 4%) with an AIS ≥ 3 in 32%. Fractures of the spine occurred in 14% (surgery 5%) with an AIS ≥ 3 in 4% and pelvic injuries were diagnosed in 16% (surgery 4%) with an AIS ≥ 3 in 14%. Injuries of the upper extremity were found in 23% (surgery 11%) with an AIS ? 3 in 5% and of the lower extremity in 32% (surge- ry 16%) with an AIS ≥ 3 in 13%.
The authors recommend a whole body CT scan in children who are potentially polytraumatized because of the detected high percentage of head and thorax injuries in polytraumatized children and the needed head surgery. The quickest imaging with a high sensitivity is the whole body CT scan which provides the clinicians with relevant information to initiate life-saving therapy.
在急诊室对多发伤儿童进行有效的初始治疗需要全面了解常见的损伤模式、发病率、死亡率及后果。所需的初始放射影像学检查仍存在争议，应根据预期的损伤模式进行调整。
在这项回顾性研究中，对2001年12月至2009年5月期间56例多发伤儿科患者（年龄≤16岁）的损伤模式进行了评估。所有儿童最初均通过全身CT扫描进行诊断。分析了事故原因、损伤部位（包括详细诊断）、致死率和损伤严重程度。采用简明损伤定级（AIS）和损伤严重度评分（ISS）对不同身体部位的损伤严重程度进行分类。此外，还调查了因初始诊断而进行的手术数量和类型。
38名男孩和18名女孩的平均ISS为30±13，平均年龄为10岁。最初24小时内的致死率分别为13%和4%。最严重且最常见的损伤是颅脑创伤，占89%，其中80%的AIS≥3。41%的患者进行了头部手术。63%的患者存在胸部损伤，其中57%的AIS≥3，11%的患者需要进行胸腔引流。34%的患者存在腹部创伤（4%进行了手术），其中32%的AIS≥3。14%的患者发生脊柱骨折（5%进行了手术），其中4%的AIS≥3；16%的患者被诊断为骨盆损伤（4%进行了手术），其中14%的AIS≥3。23%的患者存在上肢损伤（11%进行了手术），其中5%的AIS≥3；32%的患者存在下肢损伤（16%进行了手术），其中13%的AIS≥3。
作者建议对可能多发伤的儿童进行全身CT扫描，因为在多发伤儿童中检测到头部和胸部损伤的比例较高，且需要进行头部手术。全身CT扫描是最快且灵敏度高的影像学检查，可为临床医生提供启动挽救生命治疗的相关信息。
