小児外傷性高次脳機能障害の実態(A survey on post–traumatic Higher Brain Dysfunction in children at an emergency center)

要旨 小児の外傷性高次脳機能障害（post–traumatic Higher Brain Dysfunction: ptHBD）を急性期に予測し得るか，またその現状と課題について，救命救急センターの視点から検討した報告はない。そこで，2012年4月1日からの3年間に当センターが診療した15歳以下の頭部外傷のうち，外傷性脳損傷（以下，TBI）で入院加療を要し，その後自宅退院した43例を対象に，受傷時の状態，治療内容，入院中の知能検査結果およびリハビリ施設紹介の有無に関する後方視的調査と，受傷後1年以降のptHBDアンケート調査を行った。調査の同意と回答を得た26例のうち，46.2%（12/26例）にptHBDを認めた。ptHBDの有無と，入院時の頭部AIS，ISS，GCSとの間に有意差を認めなかった。ptHBDは入院中の知能検査低下群で80.0%に認めたのに対し，正常域群でも42.9%に認めた。自宅退院した小児のptHBDを入院時の外傷重症度や受傷後急性期の知能検査で予測するには限界があり，退院後のフォローアップの必要性が示唆された。今後は，受傷前の気質や家庭環境といった，ptHBDに関わる小児特有の要因を含めたさらなる長期予後調査が必要と考える。 ABSTRACT To show the actual conditions and follow of children with post–traumatic higher brain dysfunction (ptHBD) in our institute, to clarify the problems in handing over to rehabilitation setting properly, and to determine the usefulness of specific assessments in predicting ptHBD. We conducted a questionnaire survey for 43 children who had experienced traumatic brain injury (TBI) and were discharged home during April 2012 to March 2015. The questionnaire forms were sent for the children and families more than one year after injury. We also investigate clinical data from medical record such as consciousness level, treatment, result of intelligence test (Wechsler intelligence scale for children – 4th edition: WISC–IV), whether or not the patient had consulted a rehabilitation center retrospectively. Twenty–six children and their families were eligible for this questionnaire survey and 12 children (46.2%) met criteria of ptHBD. There were no significant difference between the presence of THBD and head AIS, ISS, GCS on admission. Eighty–percent of children who had low performance of WISC–IV and 42.9% of children who had normal performance of WISC– IV met ptHBD. We suggest the limitation to forecast ptHBD using the trauma severity scores and intelligence test in critical care setting.