Baerg Joanne, Thirumoorthi Arul, Hazboun Rajaie, Vannix Rosemary, Krafft Paul, Zouros Alexander
Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda University, Loma Linda, California.
Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda University, Loma Linda, California.
J Surg Res. 2017 Nov;219:366-373. doi: 10.1016/j.jss.2017.06.053. Epub 2017 Jul 26.
The aim of the study was to compare the cervical spine (c-spine) pattern of injury and outcomes in children below 3 y with a head injury from confirmed inflicted versus accidental trauma.
After Institutional Review Board approval, data were prospectively collected between July 2011 and January 2016. Inclusion criteria were age below 3 y, a loss of consciousness, and any one of the following initial head computed tomography (CT) findings (subdural hematoma, intraventricular, intraparenchymal, subarachnoid hemorrhage, or cerebral edema). A protocol of brain and neck magnetic resonance imaging and magnetic resonance angiography was instituted. Brain and neck imaging results, clinical variables, and outcomes were recorded. Data were compared by t-test for continuous and Fisher exact test for categorical variables.
73 children were identified, 52 (71%) with inflicted and 21 (29%) with accidental trauma. The median age was 11 mo; (range: 1-35 mo). Ten (14%) had c-spine injuries, 7/52 (13%) inflicted, and 3/21 (14%) accidental. The mechanism was shaking for all inflicted and motor vehicle accident or pedestrian struck for accidental c-spine injuries. The inflicted group were significantly younger (P = 0.03), had higher Injury Severity Scores (P = 0.02), subdural hematomas (P = 0.03), fractures (P = 0.03), retinal hemorrhages (P = 0.02), brain infarcts (P = 0.01), and required cardiopulmonary resuscitation (P = 0.01). Seven with inflicted trauma died from brain injury (9.5%), one had atlanto-occipital dissociation. Six mortalities (86%) had no c-spine injury. Six with inflicted c-spine injuries survived with neurologic impairment, whereas three with accidental survived without disability, including one atlanto-occipital dissociation.
Compared to accidental trauma, young children with inflicted c-spine injuries have more multisystem trauma, long-term disability from brain injury, and an injury pattern consistent with shaking.
本研究旨在比较3岁以下因确诊为虐待性创伤与意外创伤导致头部受伤的儿童的颈椎（c脊柱）损伤模式及预后。
经机构审查委员会批准后，于2011年7月至2016年1月前瞻性收集数据。纳入标准为年龄在3岁以下、意识丧失以及以下任何一项初始头部计算机断层扫描（CT）结果（硬膜下血肿、脑室内、脑实质内、蛛网膜下腔出血或脑水肿）。制定了脑和颈部磁共振成像及磁共振血管造影方案。记录脑和颈部成像结果、临床变量及预后。连续变量采用t检验，分类变量采用Fisher精确检验进行数据比较。
共确定73名儿童，52名（71%）为虐待性创伤，21名（29%）为意外创伤。中位年龄为11个月；（范围：1 - 35个月）。10名（14%）有c脊柱损伤，7/52（13%）为虐待性创伤，3/21（14%）为意外创伤。所有虐待性创伤的机制为摇晃，意外c脊柱损伤的机制为机动车事故或行人撞击。虐待性创伤组年龄显著更小（P = 0.03），损伤严重程度评分更高（P = 0.02），硬膜下血肿更多（P = 0.03），骨折更多（P = 0.03），视网膜出血更多（P = 0.02），脑梗死更多（P = 0.01），且需要心肺复苏（P = 0.01）。7名虐待性创伤儿童死于脑损伤（9.5%），1名有寰枕关节脱位。6例死亡（86%）无c脊柱损伤。6名患有虐待性c脊柱损伤的儿童存活但有神经功能障碍，而3名意外创伤儿童存活且无残疾，其中包括1名寰枕关节脱位。
与意外创伤相比，患有虐待性c脊柱损伤的幼儿多系统创伤更多，因脑损伤导致长期残疾，且损伤模式与摇晃一致。
