University of California Davis Medical Center, Department of Pediatric General, Thoracic, and Fetal Surgery. Sacramento, CA USA.
University of California Davis, Department of Public Health Sciences, Division of Biostatistics. Sacramento, USA.
J Pediatr Surg. 2021 Jun;56(6):1174-1179. doi: 10.1016/j.jpedsurg.2021.02.044. Epub 2021 Feb 24.
Traumatic brain injury (TBI) is the leading cause of death and disability in young children; however, the impact of mechanism on outcomes has not been fully evaluated. We hypothesized that children with TBI due to abuse would have a higher mortality than children with accidental TBI due to motor vehicle collisions (MVC).
We performed a retrospective review of the National Kids' Inpatient (KID) hospitalizations database of children <2 years old with TBI due to abuse or MVC (2000-2016). The primary outcome was mortality. Secondary outcomes were length of stay (LOS) and hospital charges. We investigated predictors of mortality with multivariable regression.
Of 10,965 children with TBI, 65.2% were due to abuse. Overall mortality was 9.8% (n = 1074). Abused children had longer LOS (5.7 vs 1.6 days, p < 0.0001) and higher hospital charges ($34,314 vs $19,360, p < 0.0001) than children with TBI due to MVC. The odds of mortality were 42% higher in children with abusive head trauma (OR 1.42, 95% CI 1.10-1.83, p = 0.007) compared to MVCs after adjusting for age, race, sex, neurosurgical intervention, injury severity, and insurance.
Children with abusive traumatic brain injury have increased risk of mortality, longer LOS, and higher hospital charges compared to children with TBI due to motor vehicle collision after adjusting for relevant confounders. Resources must be directed at prevention and early identification of abuse.
外伤性脑损伤（TBI）是幼儿死亡和残疾的主要原因；然而，机制对结果的影响尚未得到充分评估。我们假设，因虐待导致 TBI 的儿童的死亡率高于因机动车碰撞（MVC）导致意外 TBI 的儿童。
我们对 2000 年至 2016 年期间全国儿童住院（KID）数据库中<2 岁因虐待或 MVC 导致 TBI 的儿童进行了回顾性研究。主要结局是死亡率。次要结局是住院时间（LOS）和医院费用。我们使用多变量回归调查了死亡率的预测因素。
在 10965 名 TBI 患儿中，65.2%因虐待导致。总体死亡率为 9.8%（n=1074）。受虐待儿童的 LOS （5.7 天与 1.6 天，p<0.0001）和医院费用（34314 美元与 19360 美元，p<0.0001）均高于 MVC 患儿。调整年龄、种族、性别、神经外科干预、损伤严重程度和保险等因素后，患有虐待性头部创伤的儿童死亡的可能性比 MVC 患儿高 42%（OR 1.42，95%CI 1.10-1.83，p=0.007）。
在调整相关混杂因素后，与因机动车碰撞导致 TBI 的儿童相比，因虐待导致 TBI 的儿童的死亡率更高，住院时间更长，医院费用更高。必须将资源用于预防和早期识别虐待行为。
