Mogbo K I, Slovis T L, Canady A I, Allasio D J, Arfken C L
Department of Pediatric Imaging, Children's Hospital of Michigan, Detroit 48201-2196, USA.
Radiology. 1998 Aug;208(2):521-4. doi: 10.1148/radiology.208.2.9680586.
To define the role of computed tomography (CT) in children aged 2 years and younger with head trauma, suspected abuse, and normal neurologic findings.
From 1992 through 1995, 87 consecutive children with skull fractures visible at plain radiography were referred to child protective services for evaluation of suspected abuse. Their cases were retrospectively reviewed.
Of 67 children with normal neurologic findings, 35 (52%) were not referred for CT. No patient in this group developed delayed findings requiring further evaluation. Of the 32 (48%) who underwent head CT, only six (19%) had evidence of acute intracranial injury, despite the presence of minimal depression and stellate, multiple, and diastatic fractures. Of 20 children with acute neurologic findings, 16 (80%) had positive CT scans, which led to neurosurgical intervention in nine (45%).
No child with normal neurologic findings had a clinically important abnormality depicted at CT. CT scans did not alter clinical management, clinical outcome, or legal outcome. Thus, routine CT of all patients with skull fractures in this population may be unnecessary.
明确计算机断层扫描（CT）在2岁及以下头部外伤、疑似虐待且神经系统检查结果正常的儿童中的作用。
1992年至1995年，连续87例颅骨骨折在平片上可见的儿童被转介至儿童保护服务机构以评估疑似虐待情况。对他们的病例进行回顾性分析。
67例神经系统检查结果正常的儿童中，35例（52%）未接受CT检查。该组中无患者出现需要进一步评估的延迟性检查结果。接受头部CT检查的32例（48%）儿童中，尽管存在轻度凹陷性骨折、星芒状骨折、多发骨折和分离性骨折，但仅有6例（19%）有急性颅内损伤的证据。20例有急性神经系统检查结果的儿童中，16例（80%）CT扫描呈阳性，其中9例（45%）因此接受了神经外科干预。
神经系统检查结果正常的儿童在CT上未显示具有临床重要意义的异常。CT扫描未改变临床处理、临床结局或法律结局。因此，对该人群中所有颅骨骨折患者进行常规CT检查可能没有必要。
