轻度头部损伤：观察还是计算机断层扫描？通过文献综述和决策分析探讨经济因素。
Mild head injury: observation or computed tomography? Economic aspects by literature review and decision analysis.
作者信息
Af Geijerstam J L, Britton M, Marké L A
机构信息
The Swedish Council on Technology Assessment in Health Care (SBU) Department of Medicine, Unit of Clinical Epidemiology, Karolinska Hospital, Stockholm, Sweden.
出版信息
Emerg Med J. 2004 Jan;21(1):54-8. doi: 10.1136/emj.2003.003178.
OBJECTIVES
To compare the costs of two strategies for acute management of mild head injury: inhospital observation compared with acute computed tomography (CT) and home care.
METHODS
Studies comparing costs for the two strategies that seem to have similar outcomes for patients were systematically reviewed. A decision tree analysis to compare the costs was also constructed, based on Swedish national costs and the risks found in a recent review on mild head injury complications.
RESULTS
No studies were found that directly measured and compared risks, benefits, and costs of the two strategies. In the four studies retrieved, involving 4126 patients, the costs for hospital observation were factual, but a model was used to evaluate costs for the CT strategy. On average, costs were one third lower with CT. Also, the decision tree analysis demonstrated that the CT strategy was one third less expensive than inhospital observation. A sensitivity analysis showed this to be valid for nearly all cases. If these calculations hold true, a change of strategy could result in annual savings of pound 280,000/million inhabitants.
CONCLUSION
The CT strategy seems to cost one third less than hospital observation.
目的
比较轻度头部损伤急性处理的两种策略的成本：住院观察与急性计算机断层扫描（CT）及家庭护理。
方法
系统回顾了比较这两种对患者似乎有相似结果的策略成本的研究。还基于瑞典国家成本和近期关于轻度头部损伤并发症的综述中发现的风险构建了决策树分析来比较成本。
结果
未发现直接测量和比较这两种策略的风险、益处和成本的研究。在检索到的四项研究中，涉及4126名患者，住院观察的成本是实际的，但使用了一个模型来评估CT策略的成本。平均而言，CT的成本低三分之一。此外，决策树分析表明CT策略比住院观察便宜三分之一。敏感性分析表明这在几乎所有情况下都是有效的。如果这些计算成立，策略改变可能导致每年每百万居民节省280,000英镑。
结论
CT策略的成本似乎比住院观察低三分之一。
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