Dietrich A M, Bowman M J, Ginn-Pease M E, Kosnik E, King D R
Department of Pediatrics, Ohio State University, College of Medicine, Columbus.
Ann Emerg Med. 1993 Oct;22(10):1535-40. doi: 10.1016/s0196-0644(05)81254-5.
To assess clinical features that might reliably predict the need for computed tomography (CT) imaging in pediatric head trauma. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective cohort of 324 head CT scans performed on 322 consecutive trauma patients at an urban children's hospital.
Sixty-two percent of patients were male. The mean age was 7.1 years (10 days to 20.6 years); half were less than 5 years of age. The two most frequent mechanisms of injury were falls (32%) and motor vehicle accidents (25%). Abnormalities were detected in 74 scans. Intracranial injuries were apparent in 39 patients (12%); 16 had a concomitant fracture. An isolated cranial abnormality was observed on 35 scans (11%). Loss of consciousness, amnesia for the event, a Glasgow Coma Scale (GCS) of less than 15, and the presence of a neurologic deficit were more common in children with intracranial injury (P < .05). Vomiting, seizures, and headache were not discriminating clinical features. No single characteristic consistently identified the children with an intracranial injury. Of the 195 children who were neurologically intact (GCS, 15) at the time of presentation, 11 (5%) had evidence of intracranial pathology on CT scan.
This study demonstrates a poor correlation between the clinical symptoms of significant traumatic brain injury and findings on CT.
评估可能可靠预测小儿头部创伤中计算机断层扫描（CT）成像需求的临床特征。设计/地点/参与者类型：对一家城市儿童医院连续322例创伤患者进行的324次头部CT扫描的前瞻性队列研究。
62%的患者为男性。平均年龄为7.1岁（10天至20.6岁）；一半患者年龄小于5岁。最常见的两种受伤机制是跌倒（32%）和机动车事故（25%）。74次扫描发现异常。39例患者（12%）有颅内损伤；16例伴有骨折。35次扫描（11%）观察到孤立的颅骨异常。意识丧失、事件失忆、格拉斯哥昏迷量表（GCS）评分低于15以及存在神经功能缺损在颅内损伤儿童中更常见（P<0.05）。呕吐、癫痫发作和头痛并非具有鉴别意义的临床特征。没有单一特征能始终如一地识别出有颅内损伤的儿童。在就诊时神经功能正常（GCS，15）的195名儿童中，11名（5%）CT扫描显示有颅内病变证据。
本研究表明，严重创伤性脑损伤的临床症状与CT检查结果之间相关性较差。
