Yock-Corrales Adriana, Lee Jan Hau, Domínguez-Rojas Jesús Ángel, Caporal Paula, Roa Juan D, Fernandez-Sarmiento Jaime, González-Dambrauskas Sebastián, Zhu Yanan, Abbas Qalab, Kazzaz Yasser, Dewi Dianna Sri, Chong Shu-Ling
Emergency Department.Hospital Nacional de Niños ¨Dr. Carlos Sáenz Herrera. CCSS San José, Costa Rica.
Children's Intensive Care Unit, KK Women's and Children's Hospital. Singapore.
J Pediatr Surg. 2024 Mar;59(3):494-499. doi: 10.1016/j.jpedsurg.2023.09.038. Epub 2023 Sep 30.
We aimed to identify clinical characteristics, risk factors for diagnosis, and describe outcomes among children with AHT.
We performed an observational cohort study in tertiary care hospitals from 14 countries across Asia and Ibero-America. We included patients <5 years old who were admitted to participating pediatric intensive care units (PICUs) with moderate to severe traumatic brain injury (TBI). We performed descriptive analysis and multivariable logistic regression for risk factors of AHT.
47 (12%) out of 392 patients were diagnosed with AHT. Compared to those with accidental injuries, children with AHT were more frequently < 2 years old (42, 89.4% vs 133, 38.6%, p < 0.001), more likely to arrive by private transportation (25, 53.2%, vs 88, 25.7%, p < 0.001), but less likely to have multiple injuries (14, 29.8% vs 158, 45.8%, p = 0.038). The AHT group was more likely to suffer subdural hemorrhage (SDH) (39, 83.0% vs 89, 25.8%, p < 0.001), require antiepileptic medications (41, 87.2% vs 209, 60.6%, p < 0.001), and neurosurgical interventions (27, 57.40% vs 143, 41.40%, p = 0.038). Mortality, PICU length of stay, and functional outcomes at 3 months were similar in both groups. In the multivariable logistic regression, age <2 years old (aOR 8.44, 95%CI 3.07-23.2), presence of seizures (aOR 3.43, 95%CI 1.60-7.36), and presence of SDH (aOR 9.58, 95%CI 4.10-22.39) were independently associated with AHT.
AHT diagnosis represented 12% of our TBI cohort. Overall, children with AHT required more neurosurgical interventions and the use of anti-epileptic medications. Children younger than 2 years and with SDH were independently associated with a diagnosis of AHT.
Observational cohort study.
III.
我们旨在确定儿童虐待性头部外伤（AHT）的临床特征、诊断风险因素并描述其预后情况。
我们在亚洲和伊比利亚 - 美洲14个国家的三级医疗机构中开展了一项观察性队列研究。我们纳入了年龄小于5岁、因中度至重度创伤性脑损伤（TBI）入住参与研究的儿科重症监护病房（PICU）的患者。我们对AHT的风险因素进行了描述性分析和多变量逻辑回归分析。
392例患者中有47例（12%）被诊断为AHT。与意外伤害患儿相比，AHT患儿年龄更小（<2岁）的情况更常见（42例，89.4%对133例，38.6%，p<0.001），乘坐私人交通工具前来就诊的可能性更大（25例，53.2%对88例，25.7%，p<0.001），但合并多处损伤的可能性更小（14例，29.8%对158例，45.8%，p = 0.038）。AHT组更易发生硬膜下出血（SDH）（39例，83.0%对89例，25.8%，p<0.001），更需要使用抗癫痫药物（41例，87.2%对209例，60.6%，p<0.001），以及接受神经外科干预（27例，57.40%对143例，41.40%，p = 0.038）。两组在死亡率、PICU住院时长和3个月时的功能预后方面相似。在多变量逻辑回归分析中，年龄<2岁（调整后比值比[aOR] 8.44，95%置信区间[CI] 3.07 - 23.2）、存在癫痫发作（aOR 3.43，95%CI 1.60 - 7.36）和存在SDH（aOR 9.58，95%CI 4.10 - 22.39）与AHT独立相关。
AHT诊断占我们TBI队列的12%。总体而言，AHT患儿需要更多的神经外科干预和使用抗癫痫药物。2岁以下儿童和患有SDH与AHT诊断独立相关。
观察性队列研究。
III级。
