Department of Paediatrics, Tergooi Hospital, Blaricum, The Netherlands.
Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.
Acta Paediatr. 2019 Sep;108(9):1695-1703. doi: 10.1111/apa.14742. Epub 2019 Mar 4.
Our primary aim was to calculate the head computed tomography (CT) scan rate in children with a minor head injury (MHI) when the Dutch National guidelines were followed in clinical practice. The secondary aim was to determine the incidence of CT abnormalities and the guideline predictors associated with traumatic abnormalities.
We performed a multi-centre, prospective observational cross-sectional study in the emergency departments of six hospitals in The Netherlands between 1 April 2015 and 31 December 2016.
Data on 1002 patients were studied and 69% of cases complied with the guidelines. The overall CT rate was 44% and the incidence of traumatic abnormal CT findings was 13%. CT scans were performed in 19% of children under two years of age, 48% of children between two and five years and 63% of children aged six years or more. Multivariate regression analysis for all age categories showed that CT abnormalities were predicted by a Glasgow Coma Scale of less than 15, suspicion of a basal skull fracture, vomiting and scalp haematomas or external lesions of the skull.
Strict adherence to the Dutch national guidelines resulted in CT overuse. New guidelines are needed to safely reduce CT scan indications.
本研究旨在遵循荷兰国家指南的情况下，计算儿童轻度头部外伤（MHI）时行头部计算机断层扫描（CT）的比例。次要目的是确定 CT 异常的发生率以及与外伤性异常相关的指南预测因子。
本研究为 2015 年 4 月 1 日至 2016 年 12 月 31 日在荷兰 6 家医院的急诊科进行的一项多中心、前瞻性、观察性横断面研究。
共纳入 1002 例患者，其中 69%的患者符合指南要求。总体 CT 使用率为 44%，外伤性 CT 异常的发生率为 13%。2 岁以下儿童中 19%、2 至 5 岁儿童中 48%、6 岁及以上儿童中 63%进行了 CT 检查。所有年龄段的多变量回归分析显示，格拉斯哥昏迷量表评分<15、疑有颅底骨折、呕吐以及头皮血肿或颅骨外损伤可预测 CT 异常。
严格遵循荷兰国家指南导致 CT 过度使用。需要制定新的指南以安全减少 CT 扫描指征。
