Analysis of missed cases of abusive head trauma
Analysis of missed cases of abusive head trauma
复制标题
DOI：
10.1001/jama.281.7.621
复制
发表时间：
1999-02-17
影响因子：
120.7
通讯作者：
Hay, TC
中科院分区：
文献类型：
--
作者：
Jenny, C;Hymel, KP;Hay, TC
背景虐待性头部创伤（AHT）是一种危险的虐待儿童的形式，在幼儿中很难诊断，目的是确定在一组头部受伤的虐待儿童中，医生以前漏诊AHT的频率，并确定与未被识别的诊断相关的因素。1995年，学术儿童医院。患者173名3岁以下的儿童因虐待造成的头部损伤。主要结果测量未被诊断为AHT的头部损伤儿童的特征和漏诊的后果。结果54名173例头部外伤的受虐儿童中有31.2%在接受AHT治疗后曾就诊，但诊断不成立。这些儿童的平均正确诊断时间为7天（范围，0-189天）。在来自完整家庭的非常年幼的白色儿童和没有呼吸障碍或癫痫发作的儿童中，虐待性头部创伤更容易被识别。在7名未被识别的AHT儿童中，对放射学检查的误解导致了诊断的延迟。漏诊后再损伤15例（27.8%）。22例（40.7%）发生了与漏诊相关的内科并发症。4的5例死亡，在未被认可的AHT组可能已被提前确认abuse.Conclusion虽然诊断头部创伤可能是困难的，在没有病史，重要的是要考虑造成头部创伤的婴儿和幼儿提出非特异性的临床体征。
Context Abusive head trauma (AHT) is a dangerous form of child abuse that can be difficult to diagnose in young children.Objectives To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis.Design Retrospective chart review of cases of head trauma presenting between January 1, 1990, and December 31, 1995.Setting Academic children's hospital.Patients One hundred seventy-three children younger than 3 years with head injuries caused by abuse.Main Outcome Measures Characteristics of head-injured children in whom diagnosis of AHT was unrecognized and the consequences of the missed diagnoses.Results Fifty-four (31.2%) of 173 abused children with head injuries had been seen by physicians after AHT and the diagnosis was not recognized. The mean time to correct diagnosis among these children was 7 days (range, 0-189 days). Abusive head trauma was more likely to be unrecognized in very young white children from intact families and in children without respiratory compromise or seizures. In 7 of the children with unrecognized AHT, misinterpretation of radiological studies contributed to the delay in diagnosis. Fifteen children (27.8%) were reinjured after the missed diagnosis. Twenty-two (40.7%) experienced medical complications related to the missed diagnosis. Four of 5 deaths in the group with unrecognized AHT might have been prevented by earlier recognition of abuse.Conclusion Although diagnosing head trauma can be difficult in the absence of a history, it is important to consider inflicted head trauma in infants and young children presenting with nonspecific clinical signs.