Department of Pediatrics, Kingston General Hospital, Queen's University, 76 Stuart St, Kingston, Ontario, Canada K7L 2V7.
Pediatrics. 2012 Aug;130(2):315-23. doi: 10.1542/peds.2011-1545. Epub 2012 Jul 9.
To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children.
We searched MEDLINE, EMBASE, PubMed, conference proceedings, and reference lists to identify relevant studies. Two reviewers independently selected studies that compared clinical and/or radiographic characteristics including historical features, physical exam and imaging findings, and presenting signs or symptoms in hospitalized children ≤ 6 years old with AHT and nAHT.
Twenty-four studies were included. Meta-analysis was complicated by inconsistencies in the reporting of characteristics and high statistical heterogeneity. Notwithstanding these limitations, there were 19 clinical and radiographic variables that could be meta-analyzed and odds ratios were determined for each variable. In examining only studies deemed to be high quality, we found that subdural hemorrhage(s), cerebral ischemia, retinal hemorrhage(s), skull fracture(s) plus intracranial injury, metaphyseal fracture(s), long bone fracture(s), rib fracture(s), seizure(s), apnea, and no adequate history given were significantly associated with AHT. Epidural hemorrhage(s), scalp swelling, and isolated skull fracture(s) were significantly associated with nAHT. Subarachnoid hemorrhage(s), diffuse axonal injury, cerebral edema, head and neck bruising, any bruising, and vomiting were not significantly associated with either type of trauma.
Clinical and radiographic characteristics associated with AHT and nAHT were identified, despite limitations in the literature. This systematic review also highlights the need for consistent criteria in identifying and reporting clinical and radiographic characteristics associated with AHT and nAHT.
系统地回顾文献，以确定哪些临床和影像学特征与儿童虐待性头部外伤（AHT）和非虐待性头部外伤（nAHT）相关。
我们搜索了 MEDLINE、EMBASE、PubMed、会议记录和参考文献，以确定相关研究。两位审稿人独立选择了比较临床和/或影像学特征的研究，包括历史特征、体格检查和影像学发现以及住院的≤6 岁儿童 AHT 和 nAHT 的表现体征或症状。
共纳入 24 项研究。由于特征报告不一致和统计学高度异质性，使得荟萃分析变得复杂。尽管存在这些局限性，但仍有 19 个临床和影像学变量可以进行荟萃分析，并确定了每个变量的优势比。在仅检查被认为是高质量的研究时，我们发现硬膜下血肿、脑缺血、视网膜出血、颅骨骨折伴颅内损伤、干骺端骨折、长骨骨折、肋骨骨折、癫痫、呼吸暂停和未提供充分病史与 AHT 显著相关。硬膜外血肿、头皮肿胀和孤立性颅骨骨折与 nAHT 显著相关。蛛网膜下腔出血、弥漫性轴索损伤、脑水肿、头颈部瘀伤、任何瘀伤和呕吐与任何一种创伤均无显著相关性。
尽管文献存在局限性，但确定了与 AHT 和 nAHT 相关的临床和影像学特征。本系统评价还强调了需要在识别和报告与 AHT 和 nAHT 相关的临床和影像学特征方面制定一致的标准。
