Muñoz-Santanach David, Trenchs Sainz de la Maza Victoria, González Forster Elisa, Luaces Cubells Carles
Servicio de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, España.
Servicio de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, España.
Neurocirugia (Astur). 2014 Jul-Aug;25(4):149-53. doi: 10.1016/j.neucir.2014.05.002. Epub 2014 Jun 13.
Current guidelines on the management of mild head trauma (traumatic brain injury/TBI) do not include the presence of a skull fracture in determining the risk of intracranial injury. However, in our setting cranial radiography is still performed frequently to rule out the presence of skull fracture.
To estimate the prevalence of clinically-important traumatic brain injuries (ciTBI) in children younger than two years of age with mild TBI.
Descriptive observational study. All children attended in emergency department with mild TBI (Glasgow ≥14 points) for a year were included. We defined ciTBI as intracranial injuries that caused death or required neurosurgery, intubation for more than 24 hours, inotropic drugs or mechanical ventilation.
The study included 854 children, of which 457 (53.5%) were male. The median patient age was 11.0 months (P25-75: 7.5-17.0 months). In 741 cases (86.8%) the mechanism of TBI was a fall. In 438 cases (51.3%) skull radiography was performed. Eleven children (1.3%) had intracranial injury, but none met the criteria for ciTBI (estimated prevalence of ciTBI was 0%; CI 95%: 0%-0.4%).
Children younger than two years of age with mild TBI have low prevalence of ciTBI. Consequently, it is possible to monitor children younger than two years with a TBI without performing skull radiography.
目前关于轻度头部创伤（创伤性脑损伤/TBI）管理的指南在确定颅内损伤风险时未考虑颅骨骨折的存在。然而，在我们的医疗环境中，颅骨X线摄影仍经常用于排除颅骨骨折。
评估2岁以下轻度TBI儿童中具有临床重要性的创伤性脑损伤（ciTBI）的患病率。
描述性观察性研究。纳入所有一年内因轻度TBI（格拉斯哥评分≥14分）到急诊科就诊的儿童。我们将ciTBI定义为导致死亡或需要神经外科手术、插管超过24小时、使用血管活性药物或机械通气的颅内损伤。
该研究纳入854名儿童，其中457名（53.5%）为男性。患者年龄中位数为11.0个月（第25-75百分位数：7.5-17.0个月）。741例（86.8%）TBI的致伤机制为跌倒。438例（51.3%）进行了颅骨X线摄影。11名儿童（1.3%）有颅内损伤，但均不符合ciTBI标准（ciTBI估计患病率为0%；95%置信区间：0%-0.4%）。
2岁以下轻度TBI儿童ciTBI患病率较低。因此，对于2岁以下TBI儿童，不进行颅骨X线摄影进行监测是可行的。
