Practice management guidelines for the management of mild traumatic brain injury: The EAST Practice Management Guidelines Work Group
Practice management guidelines for the management of mild traumatic brain injury: The EAST Practice Management Guidelines Work Group
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DOI：
10.1097/00005373-200111000-00034
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发表时间：
2001-11-01
影响因子：
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通讯作者：
Salotto, AG
中科院分区：
文献类型：
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作者：
Cushman, JG;Agarwal, N;Salotto, AG
轻度创伤性脑损伤（MTBI）或脑震荡是创伤中心入院的常见原因，特别是那些主要收治钝性创伤受害者的中心。以ICD-9-CM代码850.0-850.9为代表，MTBI通常被定义为由钝加速/减速力引起的损伤，产生20分钟或更短时间的意识不清和/或短暂的逆行性遗忘，格拉斯哥昏迷量表（GCS）评分为13至15，无局灶性神经功能缺损，无颅内并发症（例如癫痫发作），计算机断层扫描正常（CT）结果。 1-3 这种短暂的意识丧失和/或逆行性遗忘被称为神经功能的短暂紊乱，并且是诊断 MTBI 的必要条件。局灶性神经功能缺损以及癫痫发作活动不属于本指南中 MTBI 的定义范围。尽管 MTBI 很常见，但对于疾病的性质、各种诊断测试的作用或紧急住院治疗的必要性尚未达成统一的共识。神经创伤教科书和大量评论文章阐述了 MTBI 的定义、流行病学和临床特征。 1-8 同样，许多研究也探讨了 CT9-31 和神经心理学测试 32-46 在 MTBI 诊断和治疗中的作用。几项研究（大部分是回顾性研究）表明，哪些患者可能最适合入院治疗，而不是评估和出院回家。 9, 47–53 从神经外科医生的角度来看，还有关于 MTBI 管理策略的其他研究。 17, 28, 31, 54–64 最后，一些出版物讨论了有关 MTBI 患者创伤后和情绪症状的复杂且知之甚少的问题。 65–69 根据这一核心知识，可以提出建议，以促进采用安全、更统一和更具成本效益的方法来理解和管理 MTBI。 9、15、70–72
Mild traumatic brain injury (MTBI), or concussion, is a common cause for admission at trauma centers, particularly those centers admitting primarily blunt trauma victims. Represented by ICD-9-CM codes 850.0–850.9, MTBI may be generally defined as an injury caused by blunt acceleration/deceleration forces which produce a period of unconsciousness for 20 minutes or less and/or brief retrograde amnesia, a Glasgow Coma Scale (GCS) score of 13 to 15, no focal neurologic deficit, no intracranial complications (eg, seizure activity), and normal computed tomography (CT) findings. 1–3 This brief loss of consciousness and/or retrograde amnesia has to be referred to as a transient disturbance of neurologic function and is a sine qua non to the diagnosis of MTBI. Focal neurologic deficits as well as seizure activity fall outside the definition of MTBI in this guideline. Despite the frequency of MTBI, there is no uniform agreement regarding the nature of the illness, the role of a variety of diagnostic tests, or the necessity of acute hospitalization. Neurotrauma textbooks and a large number of review articles have addressed the definition, epidemiology, and clinical characteristics of MTBI. 1–8 Similarly, a number of studies have examined the role of CT9–31 and neuropsychological testing32–46 in the diagnosis and management of MTBI. Several studies, mostly retrospective, suggest which patients might be best served by hospital admission versus evaluation and discharge to home. 9, 47–53 Additional studies exist regarding management strategies in MTBI from the neurosurgeon’s perspective. 17, 28, 31, 54–64 Finally, the complicated and poorly understood issues surrounding posttraumatic and emotional symptoms in patients with MTBI are discussed in several publications. 65–69 From this core of knowledge, recommendations can be made to facilitate a safe, more uniform, and cost-effective approach to the understanding and management of MTBI. 9, 15, 70–72