钝性头部外伤后格拉斯哥昏迷量表评分为14至15分的儿童单纯性脑挫伤的急性转归
Acute outcomes of isolated cerebral contusions in children with Glasgow Coma Scale scores of 14 to 15 after blunt head trauma.
作者信息
Varano Paul, Cabrera Keven I, Kuppermann Nathan, Dayan Peter S
机构信息
From the Columbia University College of Physicians and Surgeons (P.V.), and Department of Pediatrics (K.I.C., P.S.D.), Division of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York; and Departments of Emergency Medicine and Pediatrics (N.K.), University of California Davis School of Medicine, Sacramento, California.
出版信息
J Trauma Acute Care Surg. 2015 May;78(5):1039-43. doi: 10.1097/TA.0000000000000604.
BACKGROUND
Little data exist to guide the management of children with cerebral contusions after minor blunt head trauma. We therefore aimed to determine the risk of acute adverse outcomes in children with minor blunt head trauma who had cerebral contusions and no other traumatic brain injuries on computed tomography (i.e., isolated cerebral contusions).
METHODS
We conducted a secondary analysis of a public use data set originating from a prospective cohort study performed in 25 PECARN (Pediatric Emergency Care Applied Research Network) emergency departments of children younger than 18 years with blunt head trauma resulting from nontrivial injury mechanisms and with Glasgow Coma Scale (GCS) scores of 14 or 15. In this analysis, we included only children with isolated cerebral contusions. We defined a normal mental status as a GCS score of 15 and no other signs of abnormal mental status. Acute adverse outcomes included intubation longer than 24 hours because of the head trauma, neurosurgery, or death from the head injury.
RESULTS
Of 14,983 children with GCS scores of 14 or 15 who received cranial computed tomography scans in the parent study, 152 (1.0%; 95% confidence interval, 0.8-1.2%) had cerebral contusions, of which 54 (35.8%) of 151 with available data were isolated. The median age of those with isolated cerebral contusions was 9 years (interquartile range, 1-13); 31 (57.4%) had a normal mental status. Of 36 patients with available data on isolated cerebral contusion size, 34 (94.4%) were described as small. 43 (79.6%) of 54 patients with isolated cerebral contusions were hospitalized, including 16 (29.6%) of 54 to an intensive care unit. No patients with isolated cerebral contusions died, were intubated longer than 24 hours for head trauma, or required neurosurgery (95% confidence interval for all outcomes, 0-6.6%).
CONCLUSION
Children with small isolated cerebral contusions after minor blunt head trauma are unlikely to require further acute intervention, including neurosurgery, suggesting that neither intensive care unit admission nor prolonged hospitalization is generally required.
LEVEL OF EVIDENCE
Epidemiologic study, level IV.
背景
关于轻度钝性头部外伤后儿童脑挫裂伤的管理，可用数据很少。因此，我们旨在确定轻度钝性头部外伤且计算机断层扫描显示有脑挫裂伤但无其他创伤性脑损伤（即孤立性脑挫裂伤）的儿童发生急性不良后果的风险。
方法
我们对一个公开数据集进行了二次分析，该数据集源自一项前瞻性队列研究，研究对象为25个儿科急诊护理应用研究网络（PE-CARN）急诊科中18岁以下因非平凡损伤机制导致钝性头部外伤且格拉斯哥昏迷量表（GCS）评分为14或15的儿童。在该分析中，我们仅纳入了患有孤立性脑挫裂伤的儿童。我们将正常精神状态定义为GCS评分为15且无其他精神状态异常迹象。急性不良后果包括因头部外伤插管超过24小时、神经外科手术或因头部损伤死亡。
结果
在母研究中接受头颅计算机断层扫描的14983名GCS评分为14或15的儿童中，152名（1.0%；95%置信区间，百分之0.8至1.2%）有脑挫裂伤，其中151名有可用数据的儿童中有54名（35.8%）为孤立性脑挫裂伤。孤立性脑挫裂伤儿童的中位年龄为9岁（四分位间距，1至13岁）；31名（57.4%）精神状态正常。在36名有孤立性脑挫裂伤大小可用数据的患者中，34名（94.4%）被描述为小。54名孤立性脑挫裂伤患者中有43名（79.6%）住院，其中54名中有16名（29.6%）入住重症监护病房。没有孤立性脑挫裂伤患者死亡、因头部外伤插管超过24小时或需要神经外科手术（所有结局的95%置信区间，0至6.6%）。
结论
轻度钝性头部外伤后患有小的孤立性脑挫裂伤的儿童不太可能需要进一步急性干预，包括神经外科手术，这表明一般既不需要入住重症监护病房也不需要延长住院时间。
证据水平
流行病学研究，IV级。
Zotero 插件