Department of Community Child Health, Cardiff and Vale University Health Board, Cardiff, UK
Department of Community Child Health, Cardiff and Vale University Health Board, Cardiff, UK.
Arch Dis Child. 2021 Apr 21;106(5):461-466. doi: 10.1136/archdischild-2020-320192.
National guidance recommends CT-head for all children <1 year old with suspected physical abuse, and to be considered for those <2 years old to exclude abusive head trauma.
To investigate whether this guidance is followed, and the associations between clinical presentation and CT findings, to determine whether guidance could be refined.
A retrospective case note review of all children <2 years old who underwent medical assessment for suspected abuse (2009-2017). Outcome measures were frequency of CT-head, and diagnostic yield of intracranial injury, skull fracture or both.
CT-head was undertaken in 60.3% (152/252) of children <12 months old and 7.8% (13/167) of those aged 12-24 months. The diagnostic yield in children who had a CT-head was 27.1% in children <6 months old, 14.3% in those 6-12 months old (p=0.07) and 42.6% (6/13) in those 12-24 months old. For those with head swelling or neurological impairment, it was 84.2% (32/38). In children <12 months old without these clinical features, the estimated prevalence of occult head injury was 6.1% (7/115). The strongest predictors of an abnormal CT-head were swelling to the head (OR 46.7), neurological impairment (OR 20.6) and a low haemoglobin (OR 11.8).
All children <2 years of age with suspected physical abuse and neurological impairment or head swelling should undergo CT-head. Where the technical skills and the requisite expertise to interpret MRI exist, an MRI scan may be the optimal first-line neuroimaging investigation in infants who are neurologically stable with injuries unrelated to the head to minimise cranial radiation exposure.
国家指南建议对所有疑似身体受虐待的<1 岁儿童进行 CT 头部检查，并考虑对<2 岁儿童进行 CT 检查以排除虐待性头部创伤。
调查是否遵循了这一指南，以及临床特征与 CT 结果之间的关联，以确定是否可以对指南进行细化。
回顾性病例记录审查所有<2 岁因疑似虐待而接受医学评估的儿童（2009-2017 年）。主要结局指标为 CT 头部检查的频率以及颅内损伤、颅骨骨折或两者同时存在的诊断率。
<12 个月大的儿童中有 60.3%（152/252）和 12-24 个月大的儿童中有 7.8%（13/167）进行了 CT 头部检查。在进行 CT 头部检查的儿童中，<6 个月大的儿童的诊断率为 27.1%，6-12 个月大的儿童为 14.3%（p=0.07），12-24 个月大的儿童为 42.6%（6/13）。对于有头部肿胀或神经功能障碍的儿童，诊断率为 84.2%（32/38）。在无这些临床特征的<12 个月大的儿童中，隐匿性头部损伤的估计患病率为 6.1%（7/115）。CT 头部异常的最强预测因素是头部肿胀（OR 46.7）、神经功能障碍（OR 20.6）和低血红蛋白（OR 11.8）。
所有<2 岁且疑似身体受虐待、有神经功能障碍或头部肿胀的儿童均应进行 CT 头部检查。在具备解读 MRI 的技术技能和必要专业知识的情况下，对于神经功能稳定且头部以外损伤与头部无关的婴儿，MRI 扫描可能是最佳的一线神经影像学检查，以尽量减少颅部辐射暴露。
