Abstract：
UNASSIGNED: Transferring paediatric patients with suspected abusive head trauma (AHT) to paediatric neurosurgical centres, disrupts safeguarding investigations. Therefore, it is desirable that suspected AHTs are transferred only when clinically necessary. The aim of this study was to describe referral patterns of patients referred to a tertiary paediatric neurosurgical centre with suspected AHT, with the view of informing future transfer of AHT patients.
UNASSIGNED: A retrospective review was performed of all suspected AHT patients referred to the University Hospital of Wales between 2012 and 2021.
UNASSIGNED: Rates of surgery, intubation and ventilation, radiological findings and presenting GCS were compared between referred patients and those transferred for neurosurgical care. Variables were compared between the transferred and the non-transferred groups. For categorical variables, Chi-squared tests were performed, with Fisher\'s exact test used where the expected count was less than 5. Odds ratios (OR) for neurosurgical transfer with radiological or clinical features at presentation were calculated.
UNASSIGNED: A total of 76 patients were referred, of which 18 were transferred for neurosurgical care. Of these, six were intubated and ventilated. Only one transferred patient required surgery, with the remainder receiving supportive care. Amongst the transferred group, 77.8% had SDHs and 68.6% had a GCS ≥ 13 at presentation. Patients with a GCS ≥ 13 and SDHs, bilateral haematomas or a history of vomiting were significantly more likely to be transferred (OR = 4.27, 95%CI 1.01-18.00, p = .05).
UNASSIGNED: Most transferred patients with suspected AHT did not receive surgical intervention. We suggest that patients should be transferred when it is likely that they will require surgery, otherwise they should stay locally in order to complete their safeguarding investigations. Immediate transfer may not be necessary for AHT patients with a GCS ≥ 13 and either vomiting, SDHs or bilateral haematomas, provided they are unlikely to require emergency surgery.
UNASSIGNED: A retrospective review was performed of all suspected AHT patients referred to the University Hospital of Wales between 2012 and 2021.
UNASSIGNED: Rates of surgery, intubation and ventilation, radiological findings and presenting GCS were compared between referred patients and those transferred for neurosurgical care. Variables were compared between the transferred and the non-transferred groups. For categorical variables, Chi-squared tests were performed, with Fisher\'s exact test used where the expected count was less than 5. Odds ratios (OR) for neurosurgical transfer with radiological or clinical features at presentation were calculated.
UNASSIGNED: A total of 76 patients were referred, of which 18 were transferred for neurosurgical care. Of these, six were intubated and ventilated. Only one transferred patient required surgery, with the remainder receiving supportive care. Amongst the transferred group, 77.8% had SDHs and 68.6% had a GCS ≥ 13 at presentation. Patients with a GCS ≥ 13 and SDHs, bilateral haematomas or a history of vomiting were significantly more likely to be transferred (OR = 4.27, 95%CI 1.01-18.00, p = .05).
UNASSIGNED: Most transferred patients with suspected AHT did not receive surgical intervention. We suggest that patients should be transferred when it is likely that they will require surgery, otherwise they should stay locally in order to complete their safeguarding investigations. Immediate transfer may not be necessary for AHT patients with a GCS ≥ 13 and either vomiting, SDHs or bilateral haematomas, provided they are unlikely to require emergency surgery.
摘要：
■将疑似虐待性头部外伤（AHT）的儿科患者转移到儿科神经外科中心，扰乱了保护调查。因此,希望仅在临床必要时才转移可疑的AHTs。这项研究的目的是描述转诊到三级儿科神经外科中心的可疑AHT患者的转诊模式。以告知AHT患者未来的转移。
■对2012年至2021年期间转诊至威尔士大学医院的所有疑似AHT患者进行了回顾性审查。
■手术率，插管和通气，我们比较了转诊患者和接受神经外科治疗的患者的放射学结果和GCS表现.在转移组和非转移组之间比较变量。对于分类变量，进行了卡方检验，在预期计数小于5的情况下使用Fisher精确检验。计算了具有放射学或临床特征的神经外科转移的赔率比（OR）。
■共有76名患者被转诊，其中18人被转移到神经外科治疗。其中,六人已插管和通风。只有一名转院的病人需要手术,其余的人接受支持性护理。在转移的群体中，77.8%的患者有SDH，68.6%的患者有GCS≥13。GCS≥13和SDH的患者，双侧血肿或有呕吐病史的患者更容易转移(OR=4.27,95CI1.01-18.00,p=.05).
■大多数转移的疑似AHT患者没有接受手术干预。我们建议患者在可能需要手术时应该转移，否则，他们应该留在当地，以完成他们的保护调查。对于GCS≥13且呕吐的AHT患者，可能不需要立即转移。SDH或双侧血肿，如果他们不太可能需要紧急手术。
■对2012年至2021年期间转诊至威尔士大学医院的所有疑似AHT患者进行了回顾性审查。
■手术率，插管和通气，我们比较了转诊患者和接受神经外科治疗的患者的放射学结果和GCS表现.在转移组和非转移组之间比较变量。对于分类变量，进行了卡方检验，在预期计数小于5的情况下使用Fisher精确检验。计算了具有放射学或临床特征的神经外科转移的赔率比（OR）。
■共有76名患者被转诊，其中18人被转移到神经外科治疗。其中,六人已插管和通风。只有一名转院的病人需要手术,其余的人接受支持性护理。在转移的群体中，77.8%的患者有SDH，68.6%的患者有GCS≥13。GCS≥13和SDH的患者，双侧血肿或有呕吐病史的患者更容易转移(OR=4.27,95CI1.01-18.00,p=.05).
■大多数转移的疑似AHT患者没有接受手术干预。我们建议患者在可能需要手术时应该转移，否则，他们应该留在当地，以完成他们的保护调查。对于GCS≥13且呕吐的AHT患者，可能不需要立即转移。SDH或双侧血肿，如果他们不太可能需要紧急手术。
