Summary
定义
病史和体格检查
关键诊断因素
- age <3 years
- altered mental status: irritability/lethargy/coma
- clinical findings inconsistent with carer history
- retinal/vitreal hemorrhages or retinoschisis
- apnea
其他诊断因素
- no known history of trauma
- seizure
- vomiting
- loss of muscle tone
- brisk or asymmetric reflexes
- unexplained bruising
- increasing head circumference
- bulging fontanelle
- long-bone fractures
- mucosal injury or torn labial/lingual frenulum
- anogenital signs and symptoms
危险因素
- age <1 year
- peak of normal crying curve
- male caregiver
- unrelated adult household member
- male sex
- socioeconomic stressors
诊断性检查
首要检查
- cranial CT scan
- CBC
- liver function tests
- toxicology screen
- prothrombin time (PT)/activated PTT/fibrinogen/von Willebrand testing
- urinalysis
- cerebrospinal fluid analysis
- cranial MRI
需考虑的检查
- spinal MRI
- cranial ultrasound
- skeletal survey
- complementary imaging
- blood culture
- serum calcium
- serum 1,25-dihydroxy vitamin D levels (calcidiol)
- serum inorganic phosphorus
- serum parathyroid hormone (PTH)
- serum alkaline phosphatase
- skin biopsy/fibroblast culture
- postmortem exam
治疗流程
all patients
撰稿人
作者
Barney Scholefield, MBBS, BSc, MSc, MRCPCH, PhD
Consultant in Paediatric Intensive Care
NIHR Clinician Scientist
Birmingham Women’s and Children’s NHS Foundation Trust
Birmingham
UK
利益声明
BS receives grant funding from the UK NIHR Clinician Scientist Fellowship programme.
鸣谢
Dr Barney Scholefield would like to gratefully acknowledge Dr Joe Brierley, Dr Gavin Wooldridge, and Dr Alice Newton, previous contributors to this topic.
利益声明
JB, GW, and AN declare that they have no competing interests.
同行评议者
Amy Goldberg, MD
Attending Physician
Child Protection Team
Hasboro Children's Hospital
Assistant Professor of Pediatrics
Alpert Medical School
Brown University
Providence
RI
利益声明
AG declares that she has no competing interests.
Rebecca Moles, MD
Division Chief
Child Protection Program
UMass Memorial Medical Center
Worcester
MA
利益声明
RM declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Narang SK, Fingarson A, Lukefahr J; Council on Child Abuse and Neglect. Abusive head trauma in infants and children. Pediatrics. 2020 Apr;145(4):e20200203.全文 摘要
Nuño M, Pelissier L, Varshneya K, et al. Outcomes and factors associated with infant abusive head trauma in the US. J Neurosurg Pediatr. 2015 Nov;16(5):515-22.全文 摘要
National Institute for Health and Care Excellence (UK). Child maltreatment: when to suspect maltreatment in under 18s. October 2017 [internet publication].全文
Piteau SJ, Ward MG, Barrowman NJ, et al. Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics. 2012 Aug;130(2):315-23. 摘要
Christian CW, Levin AV, Committee on Child Abuse and Neglect, et al. The eye examination in the evaluation of child abuse. Pediatrics. 2018 Aug;142(2):e20181411.全文 摘要
American College of Radiology. Practice parameter for the performance and interpretation of skeletal surveys in children. 2021 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Accidental head trauma
- Birth trauma
- Central nervous system infection: meningitis and encephalitis
更多 鉴别诊断指南
- Summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces
- Pediatric life support 2022 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
更多 指南
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