Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
J Pediatr. 2011 Jun;158(6):1003-1008.e1-2. doi: 10.1016/j.jpeds.2010.11.036. Epub 2011 Jan 13.
To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders.
We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children <18 years old with blunt head trauma evaluated in 25 emergency departments.
A total of 230 children had bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8) , compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery.
In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders.
确定伴有先天性和获得性出血性疾病与不伴有此类疾病的儿童在计算机断层扫描（CT）使用和创伤性颅内出血（ICH）发生率方面的差异。
我们在一项多中心队列研究中比较了 25 家急诊科收治的 43904 例年龄＜18 岁、钝性头部创伤儿童中伴有和不伴有出血性疾病的 CT 使用情况和 ICH 发生率。
共有 230 例患儿存在出血性疾病，格拉斯哥昏迷量表（GCS）评分为 14-15 分。这些患儿的 CT 使用率高于不伴有出血性疾病且 GCS 评分为 14-15 分的患儿（风险比，2.29；95%可信区间，2.15 至 2.44）。在接受 CT 检查的患儿中，186 例伴有出血性疾病的患儿中有 2 例发生 ICH（1.1%；95%可信区间，0.1 至 3.8），而 14969 例不伴有出血性疾病的患儿中有 655 例发生 ICH（4.4%；95%可信区间，4.1-4.7；率比，0.25；95%可信区间，0.06 至 0.98）。伴有出血性疾病和 ICH 的患儿均有症状，均未接受神经外科手术。
在头部创伤患儿中，伴有出血性疾病的患儿行 CT 检查的频率是无此类疾病患儿的两倍，但ICH 发生率仅为 1.1%，且这些患儿有症状。对于无症状且伴有先天性和获得性出血性疾病的患儿，可能无需常规进行头部创伤后 CT 成像。
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