躯体虐待和非故意伤害儿童的神经结局和死亡率的预测因素：一项回顾性观察研究。

Predictors of neurologic outcomes and mortality in physically abused and unintentionally injured children: a retrospective observation study.

机构信息

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Linko Chang Gung Memorial Hospital, Taoyuan, Taiwan.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

出版信息

Eur J Med Res. 2023 Oct 17;28(1):441. doi: 10.1186/s40001-023-01430-x.

DOI:10.1186/s40001-023-01430-x

PMID:37848955

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10580634/

Abstract

OBJECTIVES

This study aimed to identify the predictors of neurologic outcomes and mortality in physically abused and unintentionally injured children admitted to intensive care units (ICUs).

METHODS

All maltreated children were admitted to pediatric, neurosurgical, and trauma ICUs between 2001 and 2019. Clinical factors, including age, sex, season of admission, identifying settings, injury severity score, etiologies, length of stay in the ICU, neurologic outcomes, and mortality, were analyzed and compared between the physically abused and unintentionally injured groups. Neurologic assessments were conducted using the Pediatric Cerebral Performance Category scale. The study was approved by the Institutional Review Board of Chang Gung Memorial Hospital and the Ethics Committee waived the requirement for informed consent because of the anonymized nature of the data.

RESULTS

A total of 2481 children were investigated; of them, there were 480 (19.3%) victims admitted to the ICUs, including 156 physically abused and 324 unintentionally injured. Age, history of prematurity, clinical outcomes, head injury, neurosurgical interventions, clinical manifestations, brain computed tomography findings, and laboratory findings significantly differed between them (all p < 0.05). Traumatic brain injury was the major etiology for admission to the ICU. The incidence of abusive head trauma was 87.1% among the physically abused group. Only 46 (29.4%) and 268 (82.7%) cases achieved favorable neurologic outcomes in the physically abused and unintentionally injured groups, respectively. Shock within 24 h, spontaneous hypothermia (body temperature, < 35 °C), and post-traumatic seizure were strongly associated with poor neurologic outcomes and mortality in both groups.

CONCLUSIONS

Initial presentation with shock, spontaneous hypothermia at ICU admission, and post-traumatic seizure were associated with poor neurologic outcomes and mortality in physically abused and unintentionally injured children.

摘要

目的

本研究旨在确定因躯体虐待和非故意伤害而入住重症监护病房（ICU）的儿童的神经预后和死亡率的预测因素。

方法

2001 年至 2019 年，所有受虐待的儿童均被收入儿科、神经外科和创伤 ICU。分析和比较了躯体虐待组和非故意伤害组之间的临床因素，包括年龄、性别、入院季节、识别环境、损伤严重程度评分、病因、ICU 住院时间、神经预后和死亡率。神经评估采用小儿脑功能分类量表进行。本研究得到长庚纪念医院机构审查委员会和伦理委员会的批准，由于数据的匿名性质，伦理委员会豁免了知情同意书的要求。

结果

共调查了 2481 名儿童，其中 480 名（19.3%）入住 ICU，包括 156 名躯体虐待和 324 名非故意伤害。年龄、早产史、临床结局、头部损伤、神经外科干预、临床表现、脑计算机断层扫描结果和实验室检查结果差异均有统计学意义（均 P < 0.05）。创伤性脑损伤是入住 ICU 的主要病因。躯体虐待组中虐待性头部创伤的发生率为 87.1%。在躯体虐待组和非故意伤害组中，分别只有 46（29.4%）和 268（82.7%）例获得良好的神经预后。24 小时内休克、入住 ICU 时自发性低体温（体温 < 35°C）和创伤后癫痫与两组不良神经预后和死亡率密切相关。