年轻、正确约束的儿童中钝性脑血管损伤发生率较低：ATOMAC 多中心研究。
Lower incidence of blunt cerebrovascular injury among young, properly restrained children: An ATOMAC multicenter study.
机构信息
From the Center for Trauma Care, Phoenix Children's (T.A.N., D.M.N, M.T., B.P.), Phoenix, Arizona; Department of Pediatric Surgery, Le Bonheur Children's Hospital (R.A.L., J.W.E.) Memphis, Tennessee; Division of Pediatric Surgery, Department of Surgery (R.A.L., J.W.E.), College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee ; Department of Surgery (D.M.N., B.P.), College of Medicine, University of Arizona, Phoenix, Arizona; Trauma Services, Children's Medical Center (M.R.), Dallas, Texas; Division of Pediatric Surgery (M.R.), University of Texas Southwestern Medical Center Dallas, Texas; Trauma Services, Oklahoma Children's Hospital (J.J.), OU Health, Oklahoma City, Oklahoma; Department of Surgery (J.J.), University of Oklahoma Health Science Center Oklahoma City, Oklahoma; Trauma Services, Arkansas Children's Hospital (R.T.M.), Little Rock, Arkansas; Department of Surgery (R.T.M.), University of Arkansas for Medical Sciences Little Rock, Arkansas; Department of Surgery, Dell Medical School (J.A.N., K.A.L.), University of Texas at Austin, Austin, Texas; and Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas (J.A.N.), Austin, Texas.
出版信息
J Trauma Acute Care Surg. 2023 Sep 1;95(3):334-340. doi: 10.1097/TA.0000000000003900. Epub 2023 Mar 11.
BACKGROUND
Motor vehicle collision (MVC) remains a leading cause of injury and death among children, but the proper use of child safety seats and restraints has lowered the risks associated with motor vehicle travel. Blunt cerebrovascular injury (BCVI) is rare but significant among children involved in MVC. This study reviewed the incidence of BCVI after MVC causing blunt injury to the head, face, or neck, comparing those that were properly restrained with those that were not.
METHODS
A prospective, multi-institutional observational study of children younger than 15 years who sustained blunt trauma to the head, face, or neck (Abbreviated Injury Scale score >0) and presented at one of six level I pediatric trauma centers from 2017 to 2020 was conducted. Diagnosis of BCVI was made either by imaging or neurological symptoms at 2-week follow-up. Restraint status among those involved in MVC was compared for each age group.
RESULTS
A total of 2,284 patients were enrolled at the 6 trauma centers. Of these, 521 (22.8%) were involved in an MVC. In this cohort, after excluding patients with missing data, 10 of 371 (2.7%) were diagnosed with a BCVI. For children younger than 12 years, none who were properly restrained suffered a BCVI (0 of 75 children), while 7 of 221 (3.2%) improperly restrained children suffered a BCVI. For children between 12 and 15 years of age, the incidence of BCVI was 2 of 36 (5.5%) for children in seat belts compared with 1 of 36 (2.8%) for unrestrained children.
CONCLUSION
In this large multicenter prospectively screened pediatric cohort, the incidence of BCVI among properly restrained children under 12 years after MVC was infrequent, while the incidence was 3.2% among those without proper restraint. This effect was not seen among children older than 12 years. Restraint status in young children may be an important factor in BCVI screening.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
背景
机动车碰撞（MVC）仍然是儿童受伤和死亡的主要原因，但儿童安全座椅和约束装置的正确使用降低了与机动车旅行相关的风险。钝性脑血管损伤（BCVI）在涉及 MVC 的儿童中很少见，但很重要。本研究回顾了 MVC 导致头部、面部或颈部钝伤后发生 BCVI 的发生率，比较了适当约束和未适当约束的患者。
方法
对 2017 年至 2020 年期间在 6 个一级儿科创伤中心就诊的头部、面部或颈部（损伤严重程度评分>0）钝伤的 15 岁以下儿童进行了前瞻性、多机构观察性研究。通过影像学或 2 周随访时的神经症状诊断 BCVI。比较了 MVC 中每个年龄组的约束状态。
结果
在 6 个创伤中心共纳入 2284 名患者。其中，521 名（22.8%）参与了 MVC。在该队列中，排除数据缺失的患者后，371 名患者中有 10 名（2.7%）诊断为 BCVI。对于 12 岁以下的儿童，没有适当约束的儿童发生 BCVI（75 名儿童中无 0 例），而 221 名不当约束的儿童中有 7 例发生 BCVI。对于 12 至 15 岁的儿童，在使用安全带的儿童中，BCVI 的发生率为 2 例（5.5%），而在未使用安全带的儿童中，BCVI 的发生率为 1 例（2.8%）。
结论
在这项大型多中心前瞻性筛选的儿科队列研究中，MVC 后 12 岁以下适当约束的儿童中 BCVI 的发生率较低，而无适当约束的儿童中发生率为 3.2%。12 岁以上儿童未见此现象。幼儿的约束状态可能是 BCVI 筛查的一个重要因素。
证据水平
预后和流行病学；IV 级。
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