Dowd M D, Krug S
Division of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
J Trauma. 1996 Jan;40(1):61-7. doi: 10.1097/00005373-199601000-00012.
The goal of this study was to describe the epidemiology, clinical presentation, diagnostic methods, and outcome in a large series of children with blunt cardiac injury (BCI).
A multicenter retrospective review of all individuals less than 18 years of age diagnosed with a BCI from 1983 to 1993 was conducted. Cases included all those with a discharge diagnosis of myocardial contusion, concussion, ventricular disruption, or unspecified BCI.
A total of 184 cases of BCI were identified in 16 participating centers. The median age was 7.4 years, and 73% were male. Myocardial contusions accounted for 95% of the diagnoses. The leading mechanisms were motor vehicle crashes involving a pedestrian (39.7%) or passenger (31.0%). The majority (87%) had multiple system trauma, with a mean Injury Severity Score of 27.2 (SD +/- 14.4). Pulmonary contusions were present in 50.5% and rib fractures in 23.0%. The most common diagnostic test performed was a 12-lead electrocardiogram (EKG) (82%), followed by a MB band of creatine phosphokinase (CPK-MB) (69%) and echocardiogram (65%). All three tests were performed in 50%. In these patients, agreement among various diagnostic test pairs was fair (echocardiogram vs. EKG, kappa = 0.27) to poor (echocardiogram vs. CPK-MB, kappa = 0.07 and EKG vs. CPK-MB, kappa = 0.08). No hemodynamically stable patient who presented with a normal sinus rhythm subsequently developed a cardiac arrhythmia or cardiac failure. There were 25 deaths (13.6%), 3 of which were caused by acute pump failure secondary to massive cardiac injury. The remainder died of head or abdominal injuries. Of the 159 (86.4%) patients surviving, 8 (5% of survivors) had significant cardiac sequela, most commonly mitral or tricuspid insufficiency or ventricular septal defect.
Pediatric BCI is usually diagnosed in the context of severe multiple system trauma and is less commonly an isolated event. Because of the lack of a standard, various diagnostic tests are used in the diagnosis of BCI, and these tests rarely agree. In hospitalized pediatric patients with BCI, unanticipated complications are rare. Significant sequela, although uncommon, do occur and follow-up of children with BCI should be ensured.
本研究旨在描述大量钝性心脏损伤（BCI）患儿的流行病学、临床表现、诊断方法及预后情况。
对1983年至1993年期间诊断为BCI的所有18岁以下个体进行多中心回顾性研究。病例包括所有出院诊断为心肌挫伤、震荡、心室破裂或未明确的BCI患者。
16个参与中心共确诊184例BCI病例。中位年龄为7.4岁，73%为男性。心肌挫伤占诊断病例的95%。主要致伤机制为涉及行人（39.7%）或乘客（31.0%）的机动车碰撞。大多数（87%）患者有多发系统创伤，平均损伤严重度评分27.2（标准差±14.4）。50.5%的患者有肺挫伤，23.0%有肋骨骨折。最常用的诊断检查是12导联心电图（EKG）（82%），其次是肌酸磷酸激酶MB同工酶（CPK-MB）（69%）和超声心动图（65%）。50%的患者三项检查都做了。在这些患者中，各种诊断检查之间的一致性一般（超声心动图与EKG，kappa = 0.27）到较差（超声心动图与CPK-MB，kappa = 0.07以及EKG与CPK-MB，kappa = 0.08）。没有窦性心律正常且血流动力学稳定的患者随后发生心律失常或心力衰竭。有25例死亡（13.6%），其中3例因严重心脏损伤继发急性泵衰竭死亡。其余患者死于头部或腹部损伤。在存活的159例（86.4%）患者中，8例（占存活者的5%）有明显的心脏后遗症，最常见的是二尖瓣或三尖瓣关闭不全或室间隔缺损。
小儿BCI通常在严重多发系统创伤背景下被诊断，较少为孤立事件。由于缺乏标准，BCI诊断中使用了各种诊断检查，且这些检查很少达成一致。在住院的小儿BCI患者中，意外并发症很少见。明显的后遗症虽不常见，但确实会发生，应确保对BCI患儿进行随访。
