Greenes D S, Schutzman S A
Division of Emergency Medicine, Department of Pediatrics, Children's Hospital, Harvard Medical School, Boston, MA, USA.
Ann Emerg Med. 1998 Dec;32(6):680-6. doi: 10.1016/s0196-0644(98)70067-8.
The objectives of this study were as follows: (1) to determine whether clinical symptoms and signs of brain injury are sensitive indicators of intracranial injury (ICI) in infants admitted with head trauma, (2) to describe the clinical characteristics of infants who have ICI in the absence of symptoms and signs of brain injury, and (3) to determine the clinical significance of those ICIs diagnosed in asymptomatic infants.
We conducted a retrospective analysis of all infants younger than 2 years of age admitted to a tertiary care pediatric hospital with acute ICI during a 6(1/2)-year period. Infants were considered symptomatic if they had loss of consciousness, history of behavior change, seizures, vomiting, bulging fontanel, retinal hemorrhages, abnormal neurologic examination, depressed mental status, or irritability. All others were considered to have occult ICI.
Of 101 infants studied, 19 (19%; 95% confidence interval [CI] 12%, 28%) had occult ICI. Fourteen of 52 (27%) infants younger than 6 months of age had occult ICI, compared with 5 of 34 (15%) infants 6 months to 1 year, and none of 15 (0%) infants older than 1 year. Eighteen (95%) infants with occult ICI had scalp contusion or hematoma, and 18 (95%) had skull fracture. Nine (47%) infants with occult ICI received therapy for the ICI. No infants with occult ICI (0%) (95% CI 0, 14%) required surgery or medical management for increased intracranial pressure. Only 1 subject (5%) with occult ICI had any late symptoms or complications: a brief, self-limited convulsion.
We found that 19 of 101 ICIs in infants admitted with head trauma were clinically occult. All 19 occult ICIs occurred in infants younger than 12 months of age, and 18 of 19 had skull fractures. None experienced serious neurologic deterioration or required surgical intervention. Physicians cannot depend on the absence of clinical signs of brain injury to exclude ICI in infants younger than 1 year of age.
本研究的目的如下：（1）确定脑损伤的临床症状和体征是否为因头部外伤入院的婴儿颅内损伤（ICI）的敏感指标；（2）描述在无脑损伤症状和体征情况下发生ICI的婴儿的临床特征；（3）确定在无症状婴儿中诊断出的那些ICI的临床意义。
我们对一家三级护理儿科医院在6年半期间收治的所有2岁以下急性ICI婴儿进行了回顾性分析。如果婴儿有意识丧失、行为改变史、癫痫发作、呕吐、囟门膨隆、视网膜出血、神经系统检查异常、精神状态低落或易激惹，则被视为有症状。所有其他婴儿被视为有隐匿性ICI。
在研究的101名婴儿中，19名（19%；95%置信区间[CI]12%，28%）有隐匿性ICI。52名6个月以下婴儿中有14名（27%）有隐匿性ICI，6个月至1岁的34名婴儿中有5名（15%），1岁以上的15名婴儿中无一例（0%）。18名（95%）有隐匿性ICI的婴儿有头皮挫伤或血肿，18名（95%）有颅骨骨折。9名（47%）有隐匿性ICI的婴儿接受了ICI治疗。没有隐匿性ICI婴儿（0%）（95%CI 0，14%）因颅内压升高需要手术或药物治疗。只有1名（5%）有隐匿性ICI的受试者有任何晚期症状或并发症：一次短暂的、自限性惊厥。
我们发现，因头部外伤入院的婴儿中，101例ICI中有19例临床上隐匿。所有19例隐匿性ICI均发生在12个月以下的婴儿中，19例中有18例有颅骨骨折。无一例出现严重神经功能恶化或需要手术干预。医生不能依赖无脑损伤临床体征来排除1岁以下婴儿的ICI。
