视网膜发现与儿科虐待头部创伤死亡风险之间的关联
Abdelrahman M Elhusseiny1, Jamal O Azhari2, Carson W Ercanbrack2
1Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
概括
在虐待头部创伤 (AHT) 中视网膜出血的严重程度和传播是儿童死亡率的强有力的预测因素. 详细的视网膜检查可以帮助评估生存结果.
科学领域:
- 眼科医生 眼科 眼科
- 儿科 儿科 儿科
- 法医医学 法医医学
背景情况:
- 滥用头部创伤 (AHT) 是一种严重的虐待儿童形式,死亡率很高.
- 视网膜出血是AHT的常见发现,但它们的预后意义需要进一步阐明.
- 了解与死亡率相关的因素对于临床管理和儿童保护至关重要.
研究的目的:
- 调查视网膜发现,系统因素和社会经济地位与被诊断患有AHT和视网膜出血的儿科患者的死亡风险之间的关联.
- 确定视网膜出血的等级,分布和形态在预测死亡率中的预后价值.
- 评估人口和社会经济因素对AHT死亡率结果的影响.
主要方法:
- 追溯分析91名被诊断患有AHT和视网膜出血的儿童的数据,使用RetCam fundus摄影.
- 视网膜出血是根据程度,传播和形态分级的,导致整体视网膜参与分类 (等级1-3).
- 使用后勤回归来分析视网膜发现,临床变量和死亡风险之间的关联,并根据人口统计和社会经济因素进行调整.
主要成果:
- 总共分析了91名儿童的182只眼睛;20%的儿童死亡.
- 高度的视网膜出血与增加的死亡风险显著相关 (P = 0.0004),死亡率从7% (第1级) 升至53% (第3级).
- 较大的出血传播 (C级) 和缺氧-缺血性损伤是死亡率的强有力的预测因素 (分别为OR=17.43和OR=115.4),而形态学和社会经济因素并不重要.
结论:
- 视网膜出血的等级和程度是儿科AHT死亡率的强有力的预测因素.
- 详细的视网膜检查为评估AHT儿童的生存结果提供了有价值的预后信息.
- 这些发现强调了彻底的眼科评估在疑似滥用头部创伤的管理的重要性.
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