The cause of infant and toddler subdural hemorrhage: A prospective study
The cause of infant and toddler subdural hemorrhage: A prospective study
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DOI：
10.1542/peds.108.3.636
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发表时间：
2001-09-01
期刊：
影响因子：
8
通讯作者：
Ellenbogen, RG
中科院分区：
文献类型：
--
作者：
Feldman, KW;Bethel, R;Ellenbogen, RG
Objective.确定儿童虐待和意外伤害的频率作为婴幼儿硬膜下出血（SDH）的原因。一个I级区域创伤中心、区域儿童医院和县法医办公室的前瞻性病例系列评估了小于或等于36个月大且患有SDH的连续儿童。排除了先前已知有出血性疾病、先前神经外科手术、先前确认的围产期脑损伤、脑膜炎、肾透析和严重脱水的儿童。同时测量医疗、视网膜、骨骼和社会工作滥用评估。采用预先确定的标准进行病因评估。从1995年3月至1998年12月，66名儿童被收治患有SDH。39例（59%）被证实滥用，15例（23%）被证实意外伤害，12例（18%）被证实原因不明。受虐待儿童的平均年龄为8.7 ± 8.1个月，意外伤害儿童的平均年龄为19.1 ± 10.0个月。39名患者中有33名（84%）的虐待性损伤的主要病史为轻微跌倒或无机制。所有意外伤害均由机动车事故或其他记录在案的重大创伤造成。慢性或混合性急性和慢性SDH仅见于受虐待儿童（17/39 [44%]）和损伤不确定的儿童（8/12 [67%]），而非意外受伤的儿童（0/15 [0%]）。在39名受虐待儿童中，20名（51%）发现长骨和/或肋骨骨折，但只有1名意外受伤的儿童。39名受虐待儿童中有28名（72%）出现视网膜出血。3例意外受伤的儿童中只有1例有出血，这与急性颅内压升高有关。近五分之一的婴儿和幼儿SDH是由无意的创伤造成的。在那些没有明显的意外创伤的人中，76%的人被证实受到虐待。受虐待的儿童年龄较小，更有可能患有慢性SDH，更有可能有多个相关的伤害。他们的受伤史通常是轻微的或没有。
Objective. To determine the frequency of child abuse and unintentional injury as a cause of infant and toddler subdural hemorrhage (SDH).Methods. A prospective case series of a level I regional trauma center, regional children's hospital, and county medical examiner's office assessed consecutive children who were less than or equal to 36 months old and had SDH. Children who had previously known hemorrhagic disease, previous neurosurgical procedure, previously recognized perinatal brain injury, meningitis, renal dialysis, and severe dehydration were excluded. Concurrent medical, retinal, skeletal, and social work abuse evaluation were measured. Etiologic assessment using predetermined criteria was conducted.Results. From March 1995 through December 1998, 66 children were admitted with SDH. Abuse was confirmed in 39 (59%), unintentional injury in 15 (23%), and indeterminate cause in 12 (18%). The mean age of abused children was 8.7 +/-8.1 months and of children with unintentional injuries was 19.1 +/- 10.0 months. The predominant presenting histories for abusive injury were a minor fall or no mechanism for 33 (84%) of 39 patients. All unintentional injuries resulted from a motor vehicle accident or other documented major trauma. Chronic or mixed acute and chronic SDH were found only in abused children (17 [44%] of 39) and in children whose injuries were indeterminate (8 [67%] of 12), not in children who were unintentionally injured (0 [0%] of 15). Long bone and/or rib fractures were found in 20 (51%) of 39 abused children but in only 1 unintentionally injured child. Retinal bleeding was present in 28 (72%) of 39 of the abused children. Only 1 of the 3 unintentionally injured children who had a retinal examination had bleeding, which was of the type associated with acute increased intracranial pressure.Conclusions. Nearly one fifth of infant and toddler SDH resulted from unintentional trauma. Of those without obvious unintentional trauma, 76% were corroborated to have been abused. Abused children were younger, more likely to have chronic SDH, and more likely to have multiple associated injuries. Their injury history usually was minor or absent.