Jacquet Coralie, Boetto Sergio, Sevely Annick, Sol Jean-Christophe, Chaix Yves, Cheuret Emmanuel
Neurologie Pédiatrique, Hôpital des Enfants CHU Purpan, Toulouse, France.
Unité de Neurochirurgie, Pôle Neurosciences, Hôpital Pierre-Paul Riquet, CHU Purpan, Toulouse, France.
Neuropediatrics. 2018 Dec;49(6):385-391. doi: 10.1055/s-0038-1668138. Epub 2018 Sep 17.
Head injury is the most common cause of child traumatology. However, there exist no treatment guidelines in children having intracranial lesions due to minor or moderate head trauma. There is little knowledge about monitoring, clinical exacerbation risk factors, or optimal duration of hospitalization. The aim of this retrospective study is to find predictive factors in the clinical course of non-severe head trauma in children, and thus to determine an optimal management strategy. Poor clinical progress was observed in only 4 out of 113 children. When there are no clinical signs and no eating disorders, an earlier discharge is entirely appropriate. Nevertheless, persistent clinical symptoms including headache, vomiting, and late onset seizure, especially in conjunction with hemodynamic disorders such as bradycardia, present a risk of emergency neurosurgery or neurological deterioration. Special attention should be paid to extradural hematoma (EDH) of more than 10 mm, which can have the most severe consequences. Clinical aggravation does not necessarily correlate with a change in follow-up imaging. Conversely, an apparent increase in the brain lesion on the scan is not consistently linked to a pejorative outcome.
头部损伤是儿童创伤学中最常见的病因。然而,对于因轻度或中度头部创伤导致颅内病变的儿童,目前尚无治疗指南。关于监测、临床病情恶化的危险因素或最佳住院时长,人们知之甚少。这项回顾性研究的目的是找出儿童非重度头部创伤临床过程中的预测因素,从而确定最佳管理策略。在113名儿童中,仅有4名观察到临床进展不佳。当没有临床症状且没有饮食障碍时,提前出院是完全合适的。然而,持续的临床症状,包括头痛、呕吐和迟发性癫痫,尤其是伴有心动过缓等血流动力学紊乱时,存在急诊神经外科手术或神经功能恶化的风险。应特别关注厚度超过10毫米的硬膜外血肿(EDH),其可能产生最严重的后果。临床病情恶化不一定与随访影像学检查的变化相关。相反,扫描显示的脑损伤明显增加并不一定与不良预后相关。