Routine follow up after head injury: a second randomised controlled trial
Routine follow up after head injury: a second randomised controlled trial
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DOI：
10.1136/jnnp.65.2.177
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发表时间：
1998-08-01
影响因子：
11
通讯作者：
Caldwell, FE
中科院分区：
文献类型：
--
作者：
Wade, DT;King, NS;Caldwell, FE
目的 - 确认因头部受伤入院的患者受益于常规提供的早期干预服务。患者和方法 - 一个拥有 56 万人的城乡混合卫生区，设有两个事故和急诊部门。大多数头部受伤患者现有的常规服务很少。所有年龄在 16 岁至 65 岁之间、因任何严重程度的头部受伤而入院的患者，无论有或没有其他损伤，都参加了试验。采用分组随机化程序的前瞻性随机化将所有符合条件的患者分配到： 由专家团队提供额外服务的一组；或接受现有标准服务的团体。患者在受伤后六个月的随访中接受评估。主要结果指标是 Rivermead 头部损伤随访问卷，这是一种经过验证且可靠的社会残疾指标。 Rivermead 脑震荡后症状调查问卷用于评估脑震荡后症状的严重程度。受伤后 7-10 天联系试验组中的每位患者，并根据需要提供评估和干预措施。这些最初侧重于提供信息、支持和建议。试验组中 46% 的患者还接受了进一步的门诊干预或通过电话获得额外支持。结果 - 登记了 314 名患者：184 名患者被随机分入试验组，130 名患者分入对照组。对于预后数据，各组在随机分组时具有可比性，并且在六个月时评估时仍然具有可比性。 132 名试验患者和 86 名对照患者在受伤后六个月进行了随访。患者的创伤后遗忘症范围从轻度（n=79，40%）、中度（n=62，32%）到重度（n=38，19%）和极重度（n=17，9%）。与对照组患者相比，试验组患者在受伤后 6 个月的随访中，社交障碍明显减少 (p = 0.01)，脑震荡后症状的严重程度也明显减轻 (p = 0.02)。结论 - 专家服务提供的早期干预措施显着降低了头部受伤后 6 个月试验组患者的社会发病率和脑震荡后症状的严重程度。根据这些结果和之前的随机对照试验的结果，提出了如何定位专业服务的建议。
Objective-To confirm that patients admitted to hospital with a head injury benefit from a routinely offered early intervention service.Patients and methods-A mixed rural and urban Health District of 560 000 people with two accident and emergency departments provided the setting. Existing routine services for most patients with head injury are minimal. All patients aged 16-65 years admitted to hospital after a head injury of any severity, with or without other injuries entered the trial. Prospective randomisation, with a block randomisation procedure was used to allocate all eligible patients to either: a group offered an additional service by a specialist team; or a group receiving existing standard services. Patients were assessed at follow up six months after injury. The primary outcome measure was the Rivermead head injury follow up questionnaire, a validated and reliable measure of social disability. The Rivermead post-concussion symptoms questionnaire was used to estimate severity of post-concussion symptoms. Each patient in the trial group was contacted 7-10 days after injury, and offered assessment and interventions as needed. These initially focused on the provision of information, support, and advice. Forty six per cent of patients in the trial group also received further outpatient intervention or additional support by telephone.Results-314 patients were registered: 184 were randomised into the trial group, 130 into the control group. For prognostic data, the groups were comparable at randomisation, and remained comparable when assessed at six months. 132 trial and 86 control patients were followed up at six months after injury. Patients' posttraumatic amnesia ranged from mild (n=79, 40%), and moderate (n=62, 32%), to severe (n=38, 19%) and very severe (n=17, 9%). The trial group patients had significantly less social disability (p=0.01) and significantly less severe post-concussion symptoms (p=0.02) at follow up at six months after injury than the control group patients.Conclusions-The early interventions offered by a specialist service significantly reduced social morbidity and severity of post-concussion symptoms in trial group patients at six months after head injury. Recommendations about how specialist services should be targeted are made both in the Light of these results and those from a previous randomised controlled trial.