University of California Davis, Department of Pediatrics, Davis, California ; University of California Davis, Department of Emergency Medicine, Davis, California.
West J Emerg Med. 2013 Feb;14(1):29-36. doi: 10.5811/westjem.2012.3.6924.
Questions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT). Our objective was to identify physician disposition preferences of children with blunt head trauma (BHT) and varying computed tomography (CT) findings.
WE SURVEYED PEDIATRIC AND GENERAL EMERGENCY PHYSICIANS (EP), PEDIATRIC NEUROSURGEONS (PNSURG), GENERAL NEUROSURGEONS (GNSURG), PEDIATRIC SURGEONS (PSURG) AND TRAUMA SURGEONS REGARDING CARE OF TWO HYPOTHETICAL PATIENTS: Case 1: a 9-year-old who fell 10 feet and Case 2: an 11-month-old who fell 5 feet. We presented various CT findings and asked physicians about disposition preferences. We evaluated predictors of patient discharge using multivariable regression analysis adjusting for hospital and ED characteristics and clinician experience. Pediatric EPs served as the reference group.
Of 2,341 eligible surveyed, 715 (31%) responded. Most would discharge children with linear skull fractures (Case 1, 71%; Case 2, 62%). Neurosurgeons were more likely to discharge children with small subarachnoid hemorrhages (Case 1 PNSurg OR 6.87, 95% CI 3.60, 13.10; GNSurg OR 6.54, 95% CI 2.38, 17.98; Case 2 PNSurg OR 5.38, 95% CI 2.64, 10.99; GNSurg OR 6.07, 95% CI 2.08, 17.76). PSurg were least likely to discharge children with any CT finding, even linear skull fractures (Case 1 OR 0.14, 95% CI 0.08, 0.23; Case 2 OR 0.18, 95% CI 0.11, 0.30). Few respondents (<6%) would discharge children with small intraventricular, subdural, or epidural bleeds.
Substantial variation exists between specialties in reported hospitalization practices of neurologically-normal children with BHT and traumatic CT findings.
围绕着遭受钝性头部创伤（BHT）的儿童应在急诊部（ED）接受何种适当的处置，存在诸多疑问。我们的目的是确定具有不同 CT 发现的钝性头部创伤（BHT）儿童的医生处置偏好。
我们调查了儿科和普通急诊医生（EP）、儿科神经外科医生（PNSurg）、普通神经外科医生（GNSurg）、儿科外科医生（PSurg）和创伤外科医生，了解他们对两名假设患者的治疗方法：病例 1：一名 9 岁儿童从 10 英尺高处坠落；病例 2：一名 11 个月大的儿童从 5 英尺高处坠落。我们提供了各种 CT 发现，并询问了医生的处置偏好。我们使用多变量回归分析评估了患者出院的预测因素，该分析调整了医院和 ED 特征以及临床医生经验。儿科 EP 作为参考组。
在 2341 名符合条件的调查对象中，有 715 名（31%）做出了回应。大多数医生会让线性颅骨骨折的患儿出院（病例 1，71%；病例 2，62%）。神经外科医生更倾向于让蛛网膜下腔少量出血的患儿出院（病例 1 PNSurg OR 6.87，95%CI 3.60，13.10；GNSurg OR 6.54，95%CI 2.38，17.98；病例 2 PNSurg OR 5.38，95%CI 2.64，10.99；GNSurg OR 6.07，95%CI 2.08，17.76）。PSurg 最不可能让任何 CT 发现的患儿出院，即使是线性颅骨骨折（病例 1 OR 0.14，95%CI 0.08，0.23；病例 2 OR 0.18，95%CI 0.11，0.30）。很少有受访者（<6%）会让脑室、硬膜下或硬膜外有少量出血的患儿出院。
在具有神经学正常的 BHT 和外伤性 CT 发现的儿童的住院治疗实践方面，不同专业之间存在很大差异。
