Roach Jonathan P, Acker Shannon N, Bensard Denis D, Sirotnak Andrew P, Karrer Frederick M, Partrick David A
Department of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA.
Pediatr Surg Int. 2014 Nov;30(11):1103-6. doi: 10.1007/s00383-014-3598-3. Epub 2014 Sep 25.
Our aim was to define the radiographic findings that help differentiate abusive head trauma (AHT) from accidental head injury.
Our trauma registry was queried for all children ≤5 years of age presenting with traumatic brain injury (TBI) from 1996-2011.
Of 2,015 children with TBI, 71% had accidental injury and 29% had AHT. Children with AHT were more severely injured (ISS 22.1 vs 14.4; p < 0.0001) and had a higher mortality rate (15 vs 5%; p < 0.0001). Patients with AHT had higher rates of diffuse axonal injury (14 vs 8%; p < 0.0001) and subdural hemorrhage (76 vs 23%; p < 0.0001). Children with accidental injury had higher rates of skull fractures (52 vs 21%; p < 0.0001) and epidural hemorrhages (11 vs 3%).
AHT occurred in 29% of children and resulted in increased mortality rates. These children had higher rates of subdural hemorrhages and diffuse axonal injury. Physicians initially evaluating injured children must maintain a high index of suspicion for abuse in those who present with subdural hematoma or diffuse axonal injury.
我们的目的是确定有助于区分虐待性头部创伤（AHT）与意外头部损伤的影像学表现。
查询我们的创伤登记系统，以获取1996年至2011年期间所有5岁及以下患有创伤性脑损伤（TBI）的儿童的信息。
在2015例TBI儿童中，71%为意外受伤，29%为AHT。AHT儿童受伤更严重（损伤严重度评分[ISS]为22.1对14.4；p<0.0001），死亡率更高（15%对5%；p<0.0001）。AHT患者弥漫性轴索损伤发生率更高（14%对8%；p<0.0001），硬膜下出血发生率更高（76%对23%；p<0.0001）。意外受伤儿童颅骨骨折发生率更高（52%对21%；p<0.0001），硬膜外出血发生率更高（11%对3%）。
29%的儿童发生AHT，导致死亡率增加。这些儿童硬膜下出血和弥漫性轴索损伤发生率更高。最初评估受伤儿童的医生对于出现硬膜下血肿或弥漫性轴索损伤的儿童必须保持高度的虐待怀疑指数。
