Masoumi Babak, Heydari Farhad, Hatamabadi Hamidreza, Azizkhani Reza, Yoosefian Zahra, Zamani Majid
Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Safety Promotion and Injury Prevention Research Center, Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Open Access Maced J Med Sci. 2017 Jun 3;5(3):319-323. doi: 10.3889/oamjms.2017.071. eCollection 2017 Jun 15.
In emergency medicine for determining the intracranial injury (ICI) in children with head trauma, usually brain CT scan is performed. Since brain CT scan, especially in children, has some disadvantages, it is better to find a procedure which could help to choose only the children with real head trauma injury for brain CT scan.
The aim of this study is to find such procedure. This study was descriptive, analytic and non-interventional.
We reviewed the archived files of children with head trauma injuries referred to the emergency department of Imam Hossein Hospital within two years. Patient's CT scan findings and head trauma risk factors were evaluated in this study.
Out of 368 patients, 326 patients had normal brain CT scan. 28 of them showed symptoms of ICI consisting intraventricular haemorrhage (IVH), contusion, subarachnoid haemorrhage (SAH), subdural haemorrhage (SDH), epidural hematoma (EDH), and pneumocephalus. Twenty-seven patients showed skull FX, which 14 of them had an Isolated fracture, and 13 of them also showed symptoms of ICI. Since patients with isolated FX usually discharge quickly from Emergency Department; their data did not include in results of the study. The patients have been divided into two groups: 1- ICI, 2- without ICI. RR (relative risk), CI (Confidence interval) and sensitivity, positive predictive value (PPV), negative predictive value (NPV) and association of these risk factors with ICI were assessed with the Chi-2 test. In the end to determine the indications of CT scan, the presence of one of these five risk factors is important including abnormal mental status, clinical symptoms of skull FX, history of vomiting, craniofacial soft tissue injury (including subgaleal hematomas or laceration) and headache.
For all other patients without these risk factors, observation and Follow Up can be used which has more advantages and less cost.
在急诊医学中，对于头部外伤的儿童进行颅内损伤（ICI）的判定时，通常会进行脑部CT扫描。由于脑部CT扫描，尤其是对儿童而言，存在一些缺点，因此最好能找到一种方法，有助于仅挑选出真正有头部外伤损伤的儿童进行脑部CT扫描。
本研究的目的是找到这样一种方法。本研究为描述性、分析性且非干预性研究。
我们回顾了两年内转诊至伊玛目侯赛因医院急诊科的头部外伤儿童的存档文件。本研究评估了患者的CT扫描结果和头部外伤风险因素。
在368例患者中，326例患者脑部CT扫描正常。其中28例出现ICI症状，包括脑室内出血（IVH）、挫伤、蛛网膜下腔出血（SAH）、硬膜下出血（SDH）、硬膜外血肿（EDH）和气颅。27例患者出现颅骨骨折（FX），其中14例为单纯骨折，13例同时伴有ICI症状。由于单纯FX患者通常从急诊科很快出院，因此他们的数据未纳入研究结果。患者被分为两组：1-ICI组，2-无ICI组。采用卡方检验评估相对危险度（RR）、置信区间（CI）以及这些危险因素与ICI的敏感性、阳性预测值（PPV）、阴性预测值（NPV）和相关性。最后，为了确定CT扫描的指征，这五个危险因素中任何一个的存在都很重要，包括精神状态异常、颅骨FX的临床症状、呕吐史、颅面部软组织损伤（包括帽状腱膜下血肿或撕裂伤）和头痛。
对于所有没有这些危险因素的其他患者，可以采用观察和随访，这样更具优势且成本更低。
