Fundarò C, Caldarelli M, Monaco S, Cota F, Giorgio V, Filoni S, Di Rocco C, Onesimo R
Department of Pediatrics, Catholic University of Rome, Rome, Italy.
Childs Nerv Syst. 2012 Jul;28(7):1063-8. doi: 10.1007/s00381-012-1717-9. Epub 2012 Feb 15.
Every year 300,000 children with accidental head trauma are admitted to Italian emergency departments. Our aims were: (1) to describe patients with minor traumatic brain injury who were admitted to pediatric departments and underwent CT, and (2) to analyze the appropriateness of management according to current guidelines.
We retrospectively analyzed patients with minor head injury (median age 4.5 years, range 1 month to 16 years) who were admitted to the pediatric department of the Catholic Medical School of Rome, from January 2005 to September 2010, who performed head CT. Univariate analysis was performed using the Fisher's exact test. Multivariate analysis was performed by logistic regression.
One hundred and seventy-four patients were enrolled in the study. Fifty-four patients (31%) had pathological CT findings. Eight patients underwent neurosurgical treatments. Vomiting was the only symptom significantly prevalent in the infant group, compared to the children group (10.7% vs. 38.9%, p = 0.007), while loss of consciousness in the children group (50.0% vs. 25.0%, p = 0.040). The relationship between scalp swelling and CT abnormalities was statistically significant in the entire population. The incidence of head abnormalities was significantly higher in children with abnormal CT (92.6% vs. 72.5%).
The best way to manage children with minor head trauma is still matter of debate. Loss of consciousness and scalp swelling are risk factors predicting brain injury that deserve CT control. The radiation risks posed by CT scanning in children must be balanced by the benefits. We believe that even though CT scans may be clinically unnecessary in many cases, the rate of scanning is justified by the even limited number of abnormalities which require neurosurgical treatment.
每年有30万名意外头部创伤儿童被送往意大利急诊科。我们的目标是：（1）描述入住儿科并接受CT检查的轻度创伤性脑损伤患者；（2）根据现行指南分析管理的适宜性。
我们回顾性分析了2005年1月至2010年9月期间入住罗马天主教医学院儿科且进行了头部CT检查的轻度头部损伤患者（中位年龄4.5岁，范围1个月至16岁）。采用Fisher精确检验进行单因素分析，通过逻辑回归进行多因素分析。
174例患者纳入研究。54例患者（31%）CT检查结果异常。8例患者接受了神经外科治疗。与儿童组相比，呕吐是婴儿组中唯一显著更常见的症状（10.7%对38.9%，p = 0.007），而儿童组意识丧失更常见（50.0%对25.0%，p = 0.040）。在整个人群中，头皮肿胀与CT异常之间的关系具有统计学意义。CT异常的儿童头部异常发生率显著更高（92.6%对72.5%）。
对于轻度头部创伤儿童的最佳管理方式仍存在争议。意识丧失和头皮肿胀是预测脑损伤的危险因素，值得进行CT检查。儿童CT扫描带来的辐射风险必须与益处相权衡。我们认为，尽管在许多情况下CT扫描可能在临床上并无必要，但鉴于需要神经外科治疗的异常情况数量有限，扫描率是合理的。
