Boehnke Mitchell, Mirsky David, Stence Nicholas, Stanley Rachel M, Lindberg Daniel M
Department of Diagnostic Radiology, Children's Hospital Colorado, 12631 East 17th Ave., Mail Stop 8200, Aurora, CO, 80045, USA.
University of Colorado School of Medicine, Aurora, CO, USA.
Pediatr Radiol. 2018 Aug;48(8):1123-1129. doi: 10.1007/s00247-018-4128-6. Epub 2018 Apr 13.
Studies evaluating small patient cohorts have found a high, but variable, rate of occult head injury in children <2 years old with concern for physical abuse. The American College of Radiology (ACR) recommends clinicians have a low threshold to obtain neuroimaging in these patients.
Our aim was to determine the prevalence of occult head injury in a large patient cohort with suspected physical abuse using similar selection criteria from previous studies. Additionally, we evaluated proposed risk factors for associations with occult head injury.
This was a retrospective, secondary analysis of data collected by an observational study of 20 U.S. child abuse teams that evaluated children who underwent subspecialty evaluation for concern of abuse. We evaluated children <2 years old and excluded those with abnormal mental status, bulging fontanelle, seizure, respiratory arrest, underlying neurological condition, focal neurological deficit or scalp injury.
One thousand one hundred forty-three subjects met inclusion criteria and 62.5% (714) underwent neuroimaging with either head computed tomography or magnetic resonance imaging. We found an occult head injury prevalence of 19.7% (141). Subjects with emesis (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), macrocephaly (OR 8.5, 95% CI 3.7-20.2), and loss of consciousness (OR 5.1, 95% CI 1.2-22.9) had higher odds of occult head injury.
Our results show a high prevalence of occult head injury in patients <2 years old with suspected physical abuse. Our data support the ACR recommendation that clinicians should have a low threshold to perform neuroimaging in patients <2 years of age.
评估小样本患者队列的研究发现，2岁以下疑似受身体虐待儿童的隐匿性头部损伤发生率较高，但存在差异。美国放射学会（ACR）建议临床医生对这些患者进行神经影像学检查的阈值应较低。
我们的目的是使用先前研究中的类似选择标准，确定一大群疑似身体虐待患者中隐匿性头部损伤的患病率。此外，我们评估了与隐匿性头部损伤相关的潜在危险因素。
这是一项回顾性二次分析，数据来自一项对20个美国儿童虐待问题小组的观察性研究，这些小组评估了因担心受虐待而接受专科评估的儿童。我们评估了2岁以下儿童，并排除了那些精神状态异常、囟门膨隆、癫痫发作、呼吸骤停、潜在神经系统疾病、局灶性神经功能缺损或头皮损伤的儿童。
1143名受试者符合纳入标准，62.5%（714名）接受了头部计算机断层扫描或磁共振成像的神经影像学检查。我们发现隐匿性头部损伤的患病率为19.7%（141名）。呕吐（比值比[OR]3.5，95%置信区间[CI]1.8 - 6.8）、巨头症（OR 8.5，95%CI 3.7 - 20.2）和意识丧失（OR 5.1，95%CI 1.2 - 22.9）的受试者发生隐匿性头部损伤的几率更高。
我们的结果显示，2岁以下疑似身体虐待患者中隐匿性头部损伤的患病率较高。我们的数据支持ACR的建议，即临床医生对2岁以下患者进行神经影像学检查的阈值应较低。
