儿童创伤性颅脑损伤致伤因素分析

Analysis of injury factors and of traumatic brain injury in children

目的分析创伤性颅脑损伤(TBI)患儿的致伤因素和预后,探究影响其严重程度的危险因素,为儿童TBI的预防和干预提供依据。方法选取2011年1月1日至2020年12月31日就诊于苏州大学附属儿童医院神经外科的6040例TBI患儿,对其致伤因素和预后做回顾性分析,并采用单因素和多因素Logistic回归分析方法,分析影响儿童TBI严重程度的因素。结果6040例患儿中,男3681例,女2359例,1~3岁者占比最高为34.0%(2056/6040),以轻度损伤为主占93.2%(5631/6040)。儿童TBI主要受伤地点为公路占35.9%(2167/6040)、家里占31.1%(1881/6040),受伤原因以高处坠落和跌倒为主,分别占34.9%(2107/6040)、34.5%(2085/6040)。1~3岁儿童在家里受伤占41.9%(861/2056),主要受伤原因为高处坠落;4~6岁儿童在公路受伤占43.8%(828/1891),主要受伤原因为跌倒。Logistic回归分析显示,儿童居住地、是否存在多发伤及脑损伤部位是儿童TBI严重程度的独立影响因素(χ^(2)=6.58、138.15、4.25,均P<0.05)。结论1~3岁儿童TBI主要发生在家里,4~6岁儿童TBI主要发生在公路,高处坠落和跌倒是儿童TBI主要受伤原因,社会、学校和家庭应根据不同年龄段采取针对性的预防教育及干预措施。居住地为农村、存在多发伤、脑损伤部位为多处的患儿损伤程度更严重,在救治TBI患儿过程中,可据此对其严重程度进行快速预判,提高TBI患儿救治效率。

Objective To analyze the injury factors and prognosis of children with traumatic brain injury(TBI),and to explore the risk factors affecting its severity,so as to provide evidence for the prevention and intervention of TBI in children.Methods A total of 6040 children with TBI who were admitted to the Department of Neurosurgery of Children's Hospital of Soochow University from January 1,2011 to December 31,2020 were selected.The injury factors and prognosis were retrospectively analyzed.Univariate and multivariate Logistic regression analysis was used to analyze the factors affecting the severity of TBI in children.Results Of the 6040 children,3681 were males and 2359 were females.The patients aged 1 to 3 years accounted for the highest proportion(34.0%,2056/6040),and most of them were mild injuries(93.2%,5631/6040).The main injury sites of children with TBI were road(35.9%,2167/6040)and home(31.1%,1881/6040),and the main causes of injury were falling from height(34.9%,2107/6040)and falling(34.5%,2085/6040).Children aged 1 to 3 years were most likely to be injured at home(41.9%,861/2056),mainly due to falling from height,while children aged 4 to 6 years were most likely to be injured on the road(43.8%,828/1891),mainly due to falling.Logistic regression analysis showed that children's residence,the presence of multiple injuries and the location of brain injury were independent influencing factors for the severity of TBI in children(χ^(2)=6.58,138.15,4.25,all P<0.05).Conclusions TBI in children aged 1 to 3 years mainly occurred at home,and in children aged 4 to 6 years mainly occurred on the road.Falling from height and falling are the main causes of TBI in children.The society,schools and families should take targeted prevention education and intervention measures according to different age groups.Children who live in rural areas,have multiple injuries,and have multiple brain injury sites are more severely injured.In the process of treating children with TBI,the severity can be quickly predicted based on this,and the treatment efficiency of children with TBI can be improved.