Indications for computed tomography in patients with mild head injury
Indications for computed tomography in patients with mild head injury
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DOI：
10.2176/nmc.47.291
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发表时间：
2007-07-01
影响因子：
1.9
通讯作者：
Shirotani, Toshiki
中科院分区：
文献类型：
--
作者：
Ono, Kenichiro;Wada, Kojiro;Shirotani, Toshiki
对1,064例患者的预后影响因素进行了分析，其中男性621例，女性443例，年龄10 - 104岁（平均46 - 23岁），轻度颅脑损伤（格拉斯哥昏迷量表[GCS]评分+/- 14），但损伤后6小时内无神经系统体征。颅内病变占4.7%（50/1,064），0.66%（7/1,064）需手术治疗。日本昏迷量表（JCS）和GCS评估具有良好的相关性（r = 0.797）。多变量分析显示，计算机断层扫描（CT）异常与年龄≥ 60岁、男性、JCS评分≥ 1、饮酒、头痛、恶心/呕吐和短暂性意识丧失/遗忘之间存在显著相关性。单因素分析显示，机动车事故中的行人、高处坠落、除打击外的其他损伤机制与颅内损伤相关。颅颌面软组织损伤与颅内损伤之间无明显相关性。枕部撞击、非额部撞击或颅骨骨折的患者更可能有颅内病变。出血倾向与CT异常无相关性。建议CT的适应症如下：JCS评分> 0，存在副症状（头痛、恶心/呕吐、呕吐/遗忘），年龄>= 60岁。这些标准将使CT的频率降低29%（309/1，064）。将这些适应症应用于随后GCS评分为14-15的患者，168例患者中有114例需要CT，13例发现颅内病变。两个拒绝CT。168例患者中有54例根据适应症不需要CT，但其中38例因社会原因（n = 21）或患者要求（n = 17）实际接受了CT检查。这些适应症的CT，包括JCS可能是有用的轻度颅脑损伤患者的管理。
The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 23 years), with mild head injury (Glasgow Coma Scale [GCS] score +/- 14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r = 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age >= 60 years, male sex, JCS score >= 1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score > 0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age >= 60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n = 21) or patient request (n = 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.