Hwang Shih Yao, Ong Jia Wei, Ng Zhi Min, Foo Ce Yu, Chua Shu Zhen, Sri Dianna, Lee Jan Hau, Chong Shu-Ling
a Yong Loo Lin School of Medicine, National University of Singapore , Singapore , Singapore.
b Department of Paediatric Medicine, KK Women's and Children's Hospital , Singapore , Singapore.
Brain Inj. 2019;33(11):1420-1424. doi: 10.1080/02699052.2019.1641625. Epub 2019 Jul 17.
Traumatic brain injury (TBI) is a significant cause of mortality and disability in the pediatric population. Non-accidental trauma (NAT) has specifically been reported to result in more severe injury as compared to accidental mechanisms of injury. We aim to investigate the long-term neurological outcomes in children with moderate to severe traumatic brain injury. Our secondary aim is to evaluate the difference in outcomes between children presenting with NAT and non-NAT, in our study population. We performed a retrospective study in a tertiary pediatric hospital between January 2008 to October 2017 of all patients with TBI <16 years old with a Glasgow Coma Scale (GCS) ≤13. The dual primary outcomes were mortality and Paediatric Functional Independence Measure (WeeFIM) scores, recorded at the start of rehabilitation, discharge, 3 months and 6 months post-injury. The secondary outcome was the development of post-traumatic epilepsy. There were 68 patients with a median age of 4.5 [interquartile range (IQR) 1.0-9.0] years old. The most common presenting symptom was vomiting for children <2 years (11/20, 55.0%) while confusion and disorientation were common for those ≥2 years (27/48, 56.3%). WeeFIM scores at the start of rehabilitation [median 122.0, IQR 33.8-126.0] improved at 6 months post-injury (median 126.0, IQR 98.5-126.0). There was a greater incidence of post-traumatic epilepsy in age <2 years (6/20, 30.0%) compared to age ≥2 years (1/48, 2.1%) ( = .002). When comparing NAT versus non-NAT survivors, cognition WeeFIM scores were significantly different at the start of rehabilitation ( = .017) and at 3 months post-injury ( = .025). NAT predicts for poorer long-term outcomes, specifically in cognition, as measured by WeeFIM scores. Younger children <2 years had a higher incidence of post-traumatic epilepsy compared to older children.
创伤性脑损伤（TBI）是儿童群体中导致死亡和残疾的重要原因。据报道，与意外伤害机制相比，非意外创伤（NAT）导致的损伤更为严重。我们旨在调查中重度创伤性脑损伤患儿的长期神经学转归。我们的次要目标是评估在我们的研究人群中，患有NAT和非NAT的患儿在转归方面的差异。我们在一家三级儿科医院进行了一项回顾性研究，研究对象为2008年1月至2017年10月期间所有年龄＜16岁、格拉斯哥昏迷量表（GCS）≤13的TBI患者。两个主要转归指标为死亡率和儿科功能独立性测量量表（小儿FIM）评分，分别在康复开始时、出院时、伤后3个月和6个月记录。次要转归指标为创伤后癫痫的发生情况。共有68例患者，中位年龄为4.5岁[四分位间距（IQR）1.0 - 9.0岁]。＜2岁儿童最常见的首发症状是呕吐（11/20，55.0%），而≥2岁儿童常见的是意识模糊和定向障碍（27/48，56.3%）。康复开始时小儿FIM评分[中位数122.0，IQR 33.8 - 126.0]在伤后6个月有所改善（中位数126.0，IQR 98.5 - 126.0）。＜2岁儿童创伤后癫痫的发生率（6/20，30.0%）高于≥2岁儿童（1/48，2.1%）（P = 0.002）。在比较NAT与非NAT幸存者时，康复开始时（P = 0.017）和伤后3个月（P = 0.025）的认知小儿FIM评分存在显著差异。NAT预示着长期转归较差，尤其是在认知方面，以小儿FIM评分衡量。＜2岁的幼儿创伤后癫痫的发生率高于大龄儿童。
