Occult intracranial injury in infants
Occult intracranial injury in infants
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DOI：
10.1016/s0196-0644(98)70067-8
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发表时间：
1998-12-01
影响因子：
6.2
通讯作者：
Schutzman, SA
中科院分区：
文献类型：
--
作者：
Greenes, DS;Schutzman, SA
研究目的：本研究的目的如下：(1) 确定脑损伤的临床症状和体征是否是因头部外伤入院的婴儿颅内损伤 (ICI) 的敏感指标；(2) 描述在没有脑损伤症状和体征的情况下发生 ICI 的婴儿的临床特征；(3) 确定在无症状婴儿中诊断的 ICI 的临床意义。 方法：我们对所有入院的 2 岁以下婴儿进行回顾性分析在 6 1/2 年内因急性 ICI 到三级儿科医院就诊。如果婴儿出现意识丧失、行为改变史、癫痫、呕吐、囟门膨出、视网膜出血、神经系统检查异常、精神状态抑郁或烦躁，则被视为有症状。所有其他婴儿均被认为患有隐匿性 ICI。结果：在研究的 101 名婴儿中，19 名（19%；95% 置信区间 [CI] 12%、28%）患有隐匿性 ICI。 52 名 6 个月以下婴儿中，有 14 名 (27%) 患有隐匿性 ICI，而 34 名 6 个月至 1 岁婴儿中，有 5 名 (15%) 患有隐匿性 ICI，1 岁以上婴儿中，15 名 (0%) 没有。 18 例（95%）隐匿性 ICI 婴儿有头皮挫伤或血肿，18 例（95%）有颅骨骨折。九名 (47%) 患有隐匿性 ICI 的婴儿接受了 ICI 治疗。 Na 患有隐匿性 ICI 的婴儿 (0%) (95% CI 0, 14%) 因颅内压升高而需要手术或药物治疗。只有 2 名隐匿性 ICI 受试者（5%）有任何晚期症状或并发症：短暂的自限性惊厥。结论：我们发现，因头部外伤入院的 101 名婴儿中，有 19 例是临床隐匿性 ICI。所有 19 例隐匿性 ICI 均发生在 12 个月以下的婴儿中，其中 19 例中有 28 例发生颅骨骨折。没有人经历严重的神经功能恶化或需要手术干预。医生不能依靠没有脑损伤的临床症状来排除 1 岁以下婴儿的 ICI。
Study objectives: 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.Methods: 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.Results: 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. Na infants with occult ICI (0%) (95% CI 0, 14%) required surgery or medical management for increased intracranial pressure. Only 2 subject(5%) with occult ICI had any late symptoms or complications: a brief, self-limited convulsion.Conclusion: 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 28 of 19 had skull fractures. None experienced serious neurologic deterioration or required surgical intervention. Physicians cannot depend an the absence of clinical signs of brain injury to exclude ICI in infants younger than 1 year of age.