National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
J Pediatr. 2018 Jun;197:241-248.e1. doi: 10.1016/j.jpeds.2018.01.075. Epub 2018 Apr 4.
To assess the distribution of injury mechanisms and activities among children with concussions in a large pediatric healthcare system.
All patients, age 0-17 years, who had at least 1 clinical encounter with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of concussion in the Children's Hospital of Philadelphia's electronic health record system from July 1, 2012 to June 30, 2014, were selected (N = 8233) and their initial concussion-related visit identified. Approximately, 20% of the patients (n = 1625) were randomly selected for manual record review to examine injury mechanisms and activities.
Overall, 70% of concussions were sports related; however, this proportion varied by age. Only 18% of concussions sustained by children aged 0-4 were sports related, compared with greater proportions for older children (67% for age 5-11, 77% for age 12-14, and 73% for age 15-17). When the concussion was not sports related, the primary mechanisms of injury were struck by an object (30%) and falls (30%).
Sports-related injuries in children older than 6 years of age contributed to the majority of concussions in this cohort; however, it is important to note that approximately one-third of concussions were from non-sports-related activities. Although there is increased participation in community and organized sports activities among children, a focus on prevention efforts in other activities where concussions occur is needed.
在大型儿科医疗体系中评估儿童脑震荡损伤机制和活动的分布情况。
从 2012 年 7 月 1 日至 2014 年 6 月 30 日，选取费城儿童医院电子健康记录系统中至少有 1 次国际疾病分类第 9 版临床修订版（ICD-9-CM）脑震荡临床诊断的 0-17 岁患儿（n=8233），并确定其首次与脑震荡相关的就诊记录。随机选取约 20%（n=1625）患儿的病历进行手工记录审查，以检查损伤机制和活动。
总体而言，70%的脑震荡与运动有关；但这一比例因年龄而异。0-4 岁儿童的脑震荡中只有 18%与运动有关，而年龄较大的儿童的这一比例更高（5-11 岁为 67%，12-14 岁为 77%，15-17 岁为 73%）。当脑震荡与运动无关时，主要损伤机制为被物体撞击（30%）和摔倒（30%）。
6 岁以上儿童的运动相关损伤导致了该队列中大多数脑震荡的发生；但需要注意的是，约三分之一的脑震荡是由非运动相关活动引起的。虽然儿童参加社区和组织体育活动的比例有所增加，但仍需要关注其他发生脑震荡的活动中的预防措施。
