Homme James Jim L
Pediatric and Adolescent Medicine Residency, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
Emerg Med Clin North Am. 2018 May;36(2):287-304. doi: 10.1016/j.emc.2017.12.015.
Visits for pediatric minor blunt head trauma continue to increase. Variability exists in clinician evaluation and management of this generally low-risk population. Clinical decision rules identify very low-risk children who can forgo neuroimaging. Observation before imaging decreases neuroimaging rates. Outcome data can be used to risk stratify children into more discrete categories. Decision aids improves knowledge and accuracy of risk perception and facilitates identification of caregiver preferences, allowing for shared decision making. For children in whom imaging is performed and is normal or shows isolated linear skull fractures, deterioration and neurosurgical intervention are rare and hospital admission can be avoided.
小儿轻度钝性头部外伤的就诊人数持续增加。对于这个总体风险较低的人群，临床医生的评估和处理存在差异。临床决策规则可识别出极低风险的儿童，这些儿童可无需进行神经影像学检查。在进行影像学检查前进行观察可降低神经影像学检查率。结局数据可用于将儿童按风险分层为更离散的类别。决策辅助工具可提高风险认知的知识和准确性，并有助于识别照顾者的偏好，从而实现共同决策。对于已进行影像学检查且结果正常或仅显示孤立线性颅骨骨折的儿童，病情恶化和神经外科干预很少见，可避免住院治疗。
