如何识别和诊断婴儿虐待性头部创伤。
How to recognize and diagnose abusive head trauma in infants.
机构信息
Centre de jeunesse de Montréal, 1001, de Maisonneuve Est, Montréal, Québec, H2L4R5, Canada.
出版信息
Ann Phys Rehabil Med. 2010 Dec;53(10):693-710. doi: 10.1016/j.rehab.2010.10.004. Epub 2010 Nov 5.
UNLABELLED
Abusive head trauma (AHT) is complex to define for establishing proper diagnosis criteria. This observation complicates greatly the diagnosis process when faced with an infant in consultation.
OBJECTIVE
This study aims at clarifying the main criteria to be considered during the medical examination and interview with the social worker.
METHOD
An exhaustive literature survey was conducted to examine carefully the symptoms and signs as risk factors proposed to physicians.
RESULTS
An analysis of the data available in the literature was quite difficult due to the various methods and the lack of real controlled studies. However, this analysis did show that the initial clinical signs and symptoms that are most frequently encountered are not very specific and can lead to a large differential diagnosis where AHT is often omitted.
CONCLUSION
The presence or combination of symptoms, even not highly specific, associated to a lack of a precise alternative diagnosis, especially in children under the age of one, should bring specialist to ask for additional brain imaging exams. The risk factors should not be taken into account for the diagnosis.
背景
虐待性头部外伤（AHT）的定义比较复杂，难以建立明确的诊断标准。当遇到需要会诊的婴儿时，这一观察结果极大地增加了诊断过程的复杂性。
目的
本研究旨在阐明在体格检查和与社会工作者面谈时需要考虑的主要标准。
方法
对文献中提出的供医生考虑的症状和体征等风险因素进行了全面的文献调查。
结果
由于各种方法和缺乏真正的对照研究，对文献中现有数据的分析相当困难。然而，该分析确实表明，最初最常遇到的临床症状和体征并非非常特异，可能导致广泛的鉴别诊断，而 AHT 往往被遗漏。
结论
即使症状不具有高度特异性，只要存在或组合存在症状，且缺乏明确的替代诊断，尤其是在 1 岁以下的儿童中，就应促使专家要求进行额外的脑部影像学检查。不应将危险因素纳入诊断标准。
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