Samuel Nir, Jacob Ron, Eilon Yael, Mashiach Tania, Shavit Itai
Pediatric Emergency Department .
Brain Inj. 2015;29(7-8):946-50. doi: 10.3109/02699052.2015.1017005. Epub 2015 May 8.
Fall is a common mechanism of injury (MOI) in young children and an important risk factor for traumatic brain injury (TBI). Most children who fall have a minor head injury (MHI), defined as a blunt head trauma that occurred in a patient who is conscious and responsive.
To seek a possible association between MOI and injury severity.
A single centre cohort study was conducted. Data were collected on patients aged 0-2 years with MHI. Clinically-significant TBI (csTBI), defined as head injury resulting in death, intubation or neurosurgery, was the primary outcome measure. Traumatic finding on CT scan (TFCT) was the secondary outcome measure.
Five hundred and ninety-five patients were analysed. Eight types of falls were identified: from ground-level, down stairs, from a bed, from a changing table, from furniture, from adult-hold, from a playground-device and from a stroller/baby-carriage. One patient (0.16%) had csTBI. Thirty-one (5.2%) underwent CT scans, TFCT was diagnosed in 17 (2.8%) patients; 10 (1.7%) linear skull-fractures, two (0.3%) depressed skull-fractures and five (0.8%) intracranial haemorrhages. Regression analysis did not reveal a statistically significant association between any of the MOI and the presence of TFCT.
The risk for csTBI was low and no association was found between MOI and injury severity.
跌倒在幼儿中是一种常见的损伤机制（MOI），也是创伤性脑损伤（TBI）的重要危险因素。大多数跌倒的儿童为轻度头部损伤（MHI），定义为在意识清醒且有反应的患者中发生的钝性头部外伤。
探寻损伤机制与损伤严重程度之间可能存在的关联。
开展了一项单中心队列研究。收集了0至2岁患有轻度头部损伤患者的数据。具有临床意义的创伤性脑损伤（csTBI），定义为导致死亡、插管或神经外科手术的头部损伤，是主要的结局指标。CT扫描上的创伤性发现（TFCT）是次要结局指标。
对595例患者进行了分析。确定了8种跌倒类型：从地面、下楼梯、从床上、从换尿布台、从家具上、从成人怀抱中、从游乐场设备上以及从婴儿车/婴儿推车上跌倒。1例患者（0.16%）发生了具有临床意义的创伤性脑损伤。31例（5.2%）接受了CT扫描，17例（2.8%）患者被诊断为CT扫描上的创伤性发现；10例（1.7%）为线性颅骨骨折，2例（0.3%）为凹陷性颅骨骨折，5例（0.8%）为颅内出血。回归分析未显示任何损伤机制与CT扫描上的创伤性发现之间存在统计学上的显著关联。
具有临床意义的创伤性脑损伤风险较低，且未发现损伤机制与损伤严重程度之间存在关联。
