Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, Sibert J R, Kemp A M
Department of Child Health, University of Wales College of Medicine, Academic Centre, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX.
BMJ. 1998 Dec 5;317(7172):1558-61. doi: 10.1136/bmj.317.7172.1558.
To identify the incidence, clinical outcome, and associated factors of subdural haemorrhage in children under 2 years of age, and to determine how such cases were investigated and how many were due to child abuse.
Population based case series.
South Wales and south west England.
Children under 2 years of age who had a subdural haemorrhage. We excluded neonates who developed subdural haemorrhage during their stay on a neonatal unit and infants who developed a subdural haemorrhage after infection or neurosurgical intervention.
Incidence and clinical outcome of subdural haemorrhage in infants, the number of cases caused by child abuse, the investigations such children received, and associated risk factors.
Thirty three children (23 boys and 10 girls) were haemorrhage. The incidence was 12.8/100 000 children/year (95% confidence interval 5.4 to 20.2). Twenty eight cases (85%) were under 1 year of age. The incidence of subdural haemorrhage in children under 1 year of age was 21.0/100 000 children/year and was therefore higher than in the older children. The clinical outcome was poor: nine infants died and 15 had profound disability. Only 22 infants had the basic investigations of a full blood count, coagulation screen, computed tomography or magnetic resonance imaging, skeletal survey or bone scan, and ophthalmological examination. In retrospect, 27 cases (82%) were highly suggestive of abuse.
Subdural haemorrhage is common in infancy and carries a poor prognosis; three quarters of such infants die or have profound disability. Most cases are due to child abuse, but in a few the cause is unknown. Some children with subdural haemorrhage do not undergo appropriate investigations. We believe the clinical investigation of such children should include a full multidisciplinary social assessment, an ophthalmic examination, a skeletal survey supplemented with a bone scan or a skeletal survey repeated at around 10 days, a coagulation screen, and computed tomography or magentic resonance imaging. Previous physical abuse in an infant is a significant risk factor for subdural haemorrhage and must be taken seriously by child protection agencies.
确定2岁以下儿童硬膜下出血的发病率、临床结局及相关因素，并确定此类病例的调查方式以及因虐待儿童导致硬膜下出血的病例数量。
基于人群的病例系列研究。
南威尔士和英格兰西南部。
患有硬膜下出血的2岁以下儿童。我们排除了在新生儿病房住院期间发生硬膜下出血的新生儿以及在感染或神经外科干预后发生硬膜下出血的婴儿。
婴儿硬膜下出血的发病率和临床结局、虐待儿童导致的病例数量、此类儿童接受的检查以及相关危险因素。
33名儿童（23名男孩和10名女孩）发生硬膜下出血。发病率为每年12.8/100000名儿童（95%置信区间为5.4至20.2）。28例（85%）患儿年龄在1岁以下。1岁以下儿童硬膜下出血的发病率为每年21.0/100000名儿童，因此高于年龄较大的儿童。临床结局较差：9名婴儿死亡，15名有严重残疾。只有22名婴儿接受了全血细胞计数、凝血筛查、计算机断层扫描或磁共振成像、骨骼检查或骨扫描以及眼科检查等基本检查。回顾性分析显示，27例（82%）高度提示为虐待所致。
硬膜下出血在婴儿期很常见，预后较差；四分之三的此类婴儿死亡或有严重残疾。大多数病例是由虐待儿童所致，但少数病例病因不明。一些患有硬膜下出血的儿童未接受适当的检查。我们认为对此类儿童的临床调查应包括全面的多学科社会评估、眼科检查、补充骨扫描的骨骼检查或在10天左右重复进行的骨骼检查、凝血筛查以及计算机断层扫描或磁共振成像。婴儿既往遭受身体虐待是硬膜下出血的一个重要危险因素，儿童保护机构必须予以重视。
