钝性头部创伤后常规重复计算机断层扫描：对患者有益吗？
Routinely repeated computed tomography after blunt head trauma: does it benefit patients?
作者信息
Kaups Krista L, Davis James W, Parks Steven N
机构信息
Department of Surgery, 4th Floor, University Medical Center, 445 South Cedar Avenue, Fresno, CA 93702, USA.
出版信息
J Trauma. 2004 Mar;56(3):475-80; discussion 480-1. doi: 10.1097/01.ta.0000114304.56006.d4.
BACKGROUND
Computed tomography of the head (HCT) is an integral part of the diagnosis and management of the patient with head injury, but the utility of repeated HCT performed solely for routine follow-up in the patient with blunt head trauma has not been defined. In the absence of clinical indications, routinely repeated HCT, even in patients with significant brain injury, does not contribute to patient care.
METHODS
Trauma registry records at a Level I trauma center from July 1, 1997, to June 30, 2002, were reviewed. Patients with severe blunt head injury (Abbreviated Injury Scale score > or = 3) admitted to the intensive care unit and who had a repeat HCT scan obtained for scheduled follow-up were included. Those patients with initial craniotomy, repeat HCT more than 72 hours after the initial HCT, or repeat HCT ordered for clinical indications were excluded. Data included were age, mechanism of injury, time to initial (HCT1) and repeat HCT (HCT2), indications for HCT2, and HCT findings. Additional data included Glasgow Coma Scale (GCS) score (admission and at HCT2); Injury Severity Score; occurrence of hypotension, coagulopathy, or elevated intracranial pressure (ICP); interventions made; and patient outcome.
RESULTS
Entry criteria were met in 462 patients. Most were injured in motor vehicle crashes; the average age was 36 years and the mean initial GCS score was 9. The mean time to HCT1 was 1.3 hours and the mean time to HCT2 was 22.6 hours. HCT2 showed worsening in 85 patients (18.4%), and 16 patients had interventions in response to HCT2 (repeat HCT in 8, ICP monitoring or drainage in 6, and craniotomy in 2). No patient undergoing routine repeat HCT without other clinical findings required intervention. All patients with worsening HCT findings requiring intervention had coagulopathy, hypotension, ICP elevation, or marked decrease in GCS score.
CONCLUSION
In the absence of clinical indicators or risk factors, repeat HCT after blunt head injury does not alter patient management and is unnecessary.
背景
头部计算机断层扫描（HCT）是头部受伤患者诊断和治疗的重要组成部分，但对于钝性头部创伤患者仅为常规随访而进行重复HCT的效用尚未明确。在没有临床指征的情况下，即使是重度脑损伤患者，常规重复进行HCT对患者治疗也没有帮助。
方法
回顾了1997年7月1日至2002年6月30日期间一级创伤中心的创伤登记记录。纳入入住重症监护病房且因计划随访而进行重复HCT扫描的重度钝性头部损伤患者（简明损伤定级评分≥3）。排除那些最初接受开颅手术、初次HCT后超过72小时进行重复HCT或因临床指征而进行重复HCT的患者。纳入的数据包括年龄、损伤机制、初次HCT（HCT1）和重复HCT（HCT2）的时间、HCT2的指征以及HCT检查结果。其他数据包括格拉斯哥昏迷量表（GCS）评分（入院时和HCT2时）；损伤严重程度评分；低血压、凝血功能障碍或颅内压（ICP）升高的发生情况；采取的干预措施；以及患者的预后。
结果
462例患者符合纳入标准。大多数患者因机动车碰撞受伤；平均年龄为36岁，初次GCS平均评分为9分。HCT1的平均时间为1.3小时，HCT2的平均时间为22.6小时。HCT2显示85例患者（18.4%）病情恶化，16例患者因HCT2结果而采取了干预措施（8例重复HCT，6例进行ICP监测或引流，2例进行开颅手术）。没有其他临床发现而仅进行常规重复HCT的患者无需干预。所有HCT检查结果恶化需要干预的患者均有凝血功能障碍、低血压、ICP升高或GCS评分显著下降。
结论
在没有临床指标或危险因素的情况下，钝性头部损伤后重复HCT不会改变患者的治疗方案，是不必要的。
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