Oluigbo Chima O, Wilkinson C Corbett, Stence Nicholas V, Fenton Laura Z, McNatt Sean A, Handler Michael H
Department of Neurosurgery, The Children's Hospital and University of Colorado, Aurora, Colorado 80045, USA.
J Neurosurg Pediatr. 2012 Feb;9(2):125-32. doi: 10.3171/2011.11.PEDS09449.
The goal of this study was to compare clinical outcomes following decompressive craniectomy performed for intracranial hypertension in children with nonaccidental, blunt cranial trauma with outcomes of decompressive craniectomy in children injured by other mechanisms.
All children in a prospectively acquired database of trauma admissions who underwent decompressive craniectomy over a 9-year span, beginning January 1, 2000, are the basis for this study. Clinical records and neuroimaging studies were systematically reviewed.
Thirty-seven children met the inclusion criteria. Nonaccidental head trauma was the most common mechanism of injury (38%). The mortality rate in patients with abusive brain injury (35.7%) was significantly higher (p < 0.05) than in patients with other causes of traumatic brain injury (4.3%). Children with inflicted head injuries had a 12-fold increase in the odds of death and 3-fold increase in the odds of a poor outcome (King's Outcome Scale for Closed Head Injury score of 1, 2, or 3).
Children with nonaccidental blunt cranial trauma have significantly higher mortality following decompressive craniectomy than do children with other mechanisms of injury. This understanding can be interpreted to mean either that the threshold for decompression should be lower in children with nonaccidental closed head injury or that decompression is unlikely to alter the path to a fatal outcome. If decompressive craniectomy is to be effective in reducing mortality in the setting of nonaccidental blunt cranial trauma, it should be done quite early.
本研究的目的是比较因非意外钝性颅脑创伤导致颅内高压而接受减压颅骨切除术的儿童的临床结局与因其他机制受伤的儿童接受减压颅骨切除术的结局。
本研究基于一个前瞻性收集的创伤入院数据库中所有在2000年1月1日开始的9年期间接受减压颅骨切除术的儿童。对临床记录和神经影像学研究进行了系统回顾。
37名儿童符合纳入标准。非意外头部创伤是最常见的损伤机制（38%）。虐待性脑损伤患者的死亡率（35.7%）显著高于其他创伤性脑损伤原因的患者（4.3%）。遭受头部损伤的儿童死亡几率增加12倍，不良结局几率增加3倍（闭合性颅脑损伤国王结局量表评分为1、2或3）。
与因其他损伤机制的儿童相比，因非意外钝性颅脑创伤接受减压颅骨切除术的儿童死亡率显著更高。这种认识可以解释为，对于非意外闭合性颅脑损伤的儿童，减压阈值应该更低，或者减压不太可能改变致命结局的路径。如果减压颅骨切除术要有效降低非意外钝性颅脑创伤情况下的死亡率，应该尽早进行。
