目的:儿童创伤性基底颅骨骨折(BSFs)中,多水平跌倒(MLF)占26.5%-37.7%。关于工作建议的信息缺乏,诊断,治疗,和耳鼻喉科随访儿童基底颅骨继发MLFs骨折。通过对某机构创伤经历的系统文献回顾和回顾性回顾,我们试图在儿科MLF患者中发现表明需要耳鼻喉科随访的临床发现.
方法:遵循PRISMA指南的两个研究小组进行了系统的文献综述。PubMed,WebofScience,8月16日对EBSCO数据库进行了检索,2020年11月20日,2021年适用于1980年后发布的英语文章,使用搜索词儿科和(跌倒或“多级跌倒”或“从高处跌倒”)和(“基底骨折”或“基底骨折”或“颅底骨折”或“颅底骨折”或“颅骨骨折”)。同时,我们对2007年至2018年期间到儿科三级护理中心就诊的所有18岁以下患者进行了机构创伤数据库和回顾性图表回顾.
结果:共确定了168篇出版物,并选择了13篇报道儿童基底颅骨骨折数据和MLF作为损伤机制的文章进行综述。MLF是BSF最常见的病因,占儿科BSF的26.5-37.7%。在回顾性审查中,研究期间有180例来自MLF的BSF(4.2%).BSF和跌倒高度显著相关(p<0.001),以及CSF泄漏和坠落高度的存在(p=0.02),颅内出血(ICH)(p=0.047),和BSF骨折类型(p<0.001)。然而,当按年龄分层时,这些关联仅存在于年轻群体中.那些非颞骨BSF(n=71),鼓室积血儿童(n=7)在就诊时听力损失的可能性(RR18.3,95%CI1.89至177.02)是无鼓室儿童(n=64)的约18倍(28.6%vs.1.6%的患者)。
结论:MLF是儿童基底颅骨骨折的最常见原因。然而,关于这种损伤机制的适当检查或耳鼻喉随访的信息有限.我们的回顾性研究表明,跌倒高度可以预测BSF,ICH,和年幼儿童的脑脊液泄漏。此外,患有非颞骨BSF和血肿的儿童可能是需要耳鼻喉科随访的重要人群。
OBJECTIVE: Multi-level fall (MLF) accounts for 26.5%-37.7% of traumatic pediatric basilar skull fractures (BSFs). There is a dearth of information concerning recommendations for work-up, diagnosis, treatment, and otolaryngological follow-up of pediatric basilar skull fractures secondary to MLFs. Through a systematic literature review and retrospective review of an institution\'s trauma experience, we sought to identify clinical findings among pediatric MLF patients that indicate the need for otolaryngological follow-up.
METHODS: A two-researcher team following the PRISMA guidelines performed a systematic literature review. PubMed, Web of Science, and EBSCO databases were searched August 16th, 2020 and again on November 20th, 2021 for English language articles published after 1980 using search terms Pediatric AND (fall OR \"multi level fall\" OR \"fall from height\") AND (\"basilar fracture\" OR \"basilar skull fracture\" OR \"skull base fracture\" OR \"skull fracture\"). Simultaneously, an institutional trauma database and retrospective chart review was performed for all patients under age 18 who presented with a MLF to a pediatric tertiary care center between 2007 and 2018.
RESULTS: 168 publications were identified and 13 articles reporting pediatric basilar skull fracture data and MLF as a mechanism of injury were selected for review. MLF is the most common etiology of BSF, accounting for 26.5-37.7% of pediatric BSFs. In the retrospective review, there were 180 cases of BSF from MLF in the study period (4.2%). BSF and fall height were significantly associated (p < 0.001), as well as presence of a CSF leak and fall height (p = 0.02), intracranial hemorrhage (ICH) (p = 0.047), and BSF fracture type (p < 0.001). However, when stratified by age, these associations were only present in the younger group. Of those with non-temporal bone BSFs (n = 71), children with hemotympanum (n = 7) were approximately 18 times more likely (RR 18.3, 95% CI 1.89 to 177.02) than children without hemotympanum (n = 64) to have hearing loss at presentation (28.6% vs. 1.6% of patients).
CONCLUSIONS: MLF is the most common cause of pediatric basilar skull fractures. However, there is limited information on the appropriate work-up or otolaryngologic follow-up for this mechanism of injury. Our retrospective review suggests fall height is predictive for BSF, ICH, and CSF leak in younger children. Also, children with non-temporal bone BSFs and hemotympanum may represent a significant population requiring otolaryngology follow-up.