Nishijima Daniel K, Holmes James F, Dayan Peter S, Kuppermann Nathan
Department of Emergency Medicine, School of Medicine, University of California-Davis, Sacramento.
Division of Pediatric Emergency Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
JAMA Pediatr. 2015 Dec;169(12):1141-7. doi: 10.1001/jamapediatrics.2015.2743.
Increased use of computed tomography (CT) in children is concerning owing to the cancer risk from ionizing radiation, particularly in children younger than 2 years. A guardian report that a child is acting abnormally is a risk factor for clinically important traumatic brain injury (ciTBI) and may be a driving factor for CT use in the emergency department.
To determine the prevalence of ciTBIs and TBIs in children younger than 2 years with minor blunt head trauma and a guardian report of acting abnormally with (1) no other findings or (2) other concerning findings for TBI.
DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of a large, prospective, multicenter cohort study that included 43 399 children younger than 18 years with minor blunt head trauma evaluated in 25 emergency departments. The study was conducted on data obtained between June 2004 and September 2006. Data analysis was performed between August 21, 2014, and March 9, 2015.
A guardian report that the child was acting abnormally after minor blunt head trauma.
The prevalence of ciTBI (defined as death, neurosurgery, intubation for >24 hours, or hospitalization for ≥2 nights in association with TBI on CT imaging) and TBI on CT imaging in children with a guardian report of acting abnormally with (1) no other findings and (2) other concerning findings for TBI.
Of 43 399 children in the cohort study, a total of 1297 children had reports of acting abnormally, of whom 411 (31.7%) had this report as their only finding. Reported as percentage (95% CI), 1 of 411 (0.2% [0-1.3%]) had a ciTBI, and 4 TBIs were noted on the CT scans in 185 children who underwent imaging (2.2% [0.6%-5.4%]). In children with reports of acting abnormally and other concerning findings for TBI, 29 of 886 (3.3% [2.2%-4.7%]) had ciTBIs and 66 of 674 (9.8% [7.7%-12.3%]) had TBIs on CT.
Clinically important TBIs are very uncommon, and TBIs noted on CT are uncommon in children younger than 2 years with minor blunt head trauma and guardian reports of the child acting abnormally with no other clinical findings suspicious for TBI. Computed tomographic scans are generally not indicated in these children although observation in the emergency department may be warranted.
由于电离辐射带来的癌症风险，儿童中计算机断层扫描（CT）的使用增加令人担忧，尤其是在2岁以下的儿童中。监护人报告孩子行为异常是临床上重要的创伤性脑损伤（ciTBI）的一个风险因素，可能是急诊科使用CT的一个驱动因素。
确定2岁以下轻度钝性头部外伤且监护人报告行为异常（1）无其他发现或（2）有其他TBI相关可疑发现的儿童中ciTBI和TBI的患病率。
设计、设置和参与者：对一项大型前瞻性多中心队列研究进行二次分析，该研究纳入了25个急诊科评估的43399名18岁以下轻度钝性头部外伤儿童。研究基于2004年6月至2006年9月期间获得的数据进行。数据分析于2014年8月21日至2015年3月9日进行。
监护人报告孩子在轻度钝性头部外伤后行为异常。
监护人报告行为异常（1）无其他发现和（2）有其他TBI相关可疑发现的儿童中ciTBI（定义为与CT成像上的TBI相关的死亡、神经外科手术、插管超过24小时或住院≥2晚）和CT成像上TBI的患病率。
在队列研究的43399名儿童中，共有1297名儿童有行为异常的报告，其中411名（31.7%）仅有此报告。以百分比（95%CI）表示。411名中有1名（0.2%[0 - 1.3%]）发生ciTBI，在185名接受成像的儿童中，CT扫描发现4例TBI（2.2%[0.6% - 5.4%]）。在有行为异常报告且有其他TBI相关可疑发现的儿童中，886名中有29名（3.3%[2.2% - 4.7%]）发生ciTBI，674名中有66名（9.8%[7.7% - 12.3%]）CT检查发现有TBI。
临床上重要的TBI非常罕见，在2岁以下轻度钝性头部外伤且监护人报告孩子行为异常但无其他TBI可疑临床发现的儿童中，CT检查发现的TBI也不常见。这些儿童一般不建议进行计算机断层扫描，不过在急诊科进行观察可能是必要的。
