Gruskin K D, Schutzman S A
Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Arch Pediatr Adolesc Med. 1999 Jan;153(1):15-20. doi: 10.1001/archpedi.153.1.15.
To determine the incidence of skull fracture (SF) and intracranial injury (ICA) among children younger than 2 years evaluated in a pediatric emergency department for head trauma; whether historical features and/or physical findings are predictive of injury type; and whether clinical criteria could allow a selective approach to radiographic imaging.
Retrospective medical record review.
Tertiary pediatric emergency department.
Case series of 278 children aged younger than 24 months evaluated for head injury.
Presence of SF and/or ICA.
Diagnoses at discharge included 227 minor head injuries, 39 isolated SF, 9 ICA with SF, and 3 isolated ICA. Children younger than 12 months had the highest incidence of SF/ICA (29%) vs 4% for children aged 13 to 24 months (P<.001). Seven percent of complications from SF/ICA resulted from falls 3 ft (0.9 m) or less [corrected]. Incidence of behavioral change, loss of consciousness, emesis, and seizures did not differ significantly between those with minor head injuries and those with SF/ICA. Scalp abnormalities were more common in children with SF/ICA (P<.001). Sixty-two percent of children with isolated SF and 58% of children with ICA had no history of loss of consciousness, emesis, seizure, or behavioral change. Ninety-two percent of children with isolated SF and 75% of children with ICA had normal levels of consciousness and nonfocal neurologic examinations at diagnosis. Among children who fell 3 ft or less (0.9 m) [corrected] and had no loss of consciousness, emesis, seizure, behavioral change, or scalp abnormality, none of 31 (95% confidence interval [CI], 0-0.10) children younger than 24 months and none of 20 (95% CI, 0-0.15) children younger than 12 months had SF/ICA.
Both SF and ICA are common in children younger than 2 years evaluated for head trauma. Children younger than 12 months are at highest risk. Injuries resulted from relatively minor falls and occurred in alert, neurologically normal children. Clinical signs and symptoms were insensitive predictors of SF/ICA; however, a grouping of features (fall < or = 3 ft [0.9 m], no history of neurologic symptoms, and normal scalp physical examination results) identified a subset of children at low risk for complications.
确定在儿科急诊科因头部外伤接受评估的2岁以下儿童中颅骨骨折（SF）和颅内损伤（ICA）的发生率；病史特征和/或体格检查结果是否可预测损伤类型；以及临床标准是否能允许采用选择性的影像学检查方法。
回顾性病历审查。
三级儿科急诊科。
278名年龄小于24个月因头部受伤接受评估的儿童病例系列。
SF和/或ICA的存在情况。
出院诊断包括227例轻度头部损伤、39例孤立性SF、9例伴有SF的ICA和3例孤立性ICA。12个月以下儿童的SF/ICA发生率最高（29%），而13至24个月儿童为4%（P<0.001）。SF/ICA并发症的7%是由3英尺（0.9米）或更低高度的跌倒导致的[校正后]。轻度头部损伤患儿与SF/ICA患儿在行为改变、意识丧失、呕吐和癫痫发作的发生率上无显著差异。头皮异常在SF/ICA患儿中更常见（P<0.001）。62%的孤立性SF患儿和58%的ICA患儿无意识丧失、呕吐、癫痫发作或行为改变的病史。92%的孤立性SF患儿和75%的ICA患儿在诊断时意识水平正常且神经系统检查无局灶性异常。在跌倒3英尺或更低高度（0.9米）[校正后]且无意识丧失、呕吐、癫痫发作、行为改变或头皮异常的儿童中，24个月以下的31名儿童（95%置信区间[CI]，0 - 0.10）和12个月以下的20名儿童（95%CI，0 - 0.15）均无SF/ICA。
在因头部外伤接受评估的2岁以下儿童中，SF和ICA均很常见。12个月以下儿童风险最高。损伤由相对较小的跌倒导致，且发生在警觉、神经系统正常的儿童中。临床体征和症状对SF/ICA的预测不敏感；然而，一组特征（跌倒≤3英尺[0.9米]、无神经系统症状病史且头皮体格检查结果正常）可识别出并发症风险较低的儿童亚组。
