婴儿头颅骨骨折伴隐匿性虐待伤
Occult abusive injuries in infants with apparently isolated skull fractures.
机构信息
Freddie Mac Foundation Child and Adolescent Protection Center (K.P.D.),Children's National Medical Center, George Washington University School ofMedicine and Health Sciences, Washington, District of Columbia, USA.
出版信息
J Trauma Acute Care Surg. 2013 Jun;74(6):1553-8. doi: 10.1097/TA.0b013e31828b7fc4.
BACKGROUND
There is currently no consensus about which screening studies should be undertaken to identify abusive injuries in infants with apparently isolated skull fractures. Our objective was to determine rates of screening, rates of injury identification, and rates of reporting to child protective services among infants who underwent subspecialty evaluation for abuse after presenting with an apparently isolated skull fracture.
METHODS
This was a retrospectively planned, secondary analysis of index children enrolled in a large network of children with concerns for physical abuse. For this analysis, we included infants (<12 months) who presented with signs and symptoms attributable to a skull fracture. We determined rates of skeletal survey, dedicated ophthalmologic examination and abdominal injury screening, rates of injury identification by testing and reports to child protective services.
RESULTS
A total of 215 infants underwent abuse consultation for apparently isolated skull fractures. Skeletal surveys were performed in 201 subjects (93.4%) and identified additional fractures in 12 (5.6%; 95% confidence interval, 2.9-9.6%). Patient age, trauma history, and fracture type (simple/complex) were not sensitive predictors of finding additional fractures on skeletal survey. Only one additional fracture was associated with clinical signs or symptoms. Dedicated ophthalmologic examination was undertaken in 100 subjects (46.5%); one child had retinal hemorrhages. Hepatic transaminases were obtained in 135 subjects (62.7%), and 5 subjects (2.3%) had abdominal computed tomography. No abdominal injuries were identified. A total of 146 subjects (67.9%) were reported to child protective services.
CONCLUSION
Infants with apparently isolated skull fractures are an important fraction of consultations for physical abuse. Additional fractures are identified in a small subset of the skeletal surveys completed in these children.
LEVEL OF EVIDENCE
Epidemiological study, level IV.
背景
目前对于哪些筛查研究应该用于识别婴儿中明显孤立性颅骨骨折的虐待性损伤尚无共识。我们的目的是确定在因疑似孤立性颅骨骨折就诊并接受虐待专科评估的婴儿中，进行筛查的比例、识别损伤的比例以及向儿童保护服务机构报告的比例。
方法
这是对一个关注身体虐待的大型儿童网络中纳入的索引儿童进行的回顾性计划的二次分析。在本分析中，我们纳入了有颅骨骨折相关体征和症状的婴儿。我们确定了骨骼调查、专门的眼科检查和腹部损伤筛查的比例，通过检测识别损伤的比例以及向儿童保护服务机构报告的比例。
结果
共有 215 名婴儿因疑似孤立性颅骨骨折接受了虐待咨询。201 名（93.4%）进行了骨骼检查，发现了 12 例（5.6%；95%置信区间，2.9-9.6%）额外骨折。患者年龄、创伤史和骨折类型（单纯/复杂）对骨骼检查中发现额外骨折均无敏感性预测作用。只有一个额外骨折与临床体征或症状相关。100 名（46.5%）进行了专门的眼科检查，1 名儿童有视网膜出血。135 名（62.7%）获得了肝转氨酶，5 名（2.3%）进行了腹部计算机断层扫描。未发现腹部损伤。共有 146 名（67.9%）向儿童保护服务机构报告。
结论
疑似孤立性颅骨骨折的婴儿是身体虐待咨询的一个重要部分。在这些儿童中完成的骨骼检查中，只有一小部分发现了额外骨折。
证据水平
流行病学研究，IV 级。
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