Imhof H G, Dolder E, Käch K, Künzi W, Platz A, Rüttner B, Vollenweider A
Neurochirurgische Klinik, Universitätsspital Zürich.
Helv Chir Acta. 1992 Mar;58(5):667-72.
The frequency of minor closed head injuries is high. These injuries may be complicated by the development of life-threatening intracranial hematomas. A well-defined selection criteria for admission must be proposed to guarantee an efficacious observation. In our series of 489 hospitalized patients with a GCS of 15 when seen in the emergency room: 4 patients required evacuation of an intracranial hematoma, 11 revision of a depressed skull fracture or a compound fracture of base of the anterior fossa. Using the existence of a skull fracture as a selection for admission, a strategy proposed by Jennett and colleagues, it would have been possible to reduce the number of patients hospitalized by 70% without missing a patient who developed an intracranial hematoma. Following these criteria no intracranial hematoma would be missed in our patients with a GCS of 15. We suggest that the use of plain x-rays to identify skull fractures and subsequent hospitalization prevents missing an intracranial hematoma. Those patients with diminished levels of consciousness of focal neurologic deficits require admission irrespective of skull fractures.
轻度闭合性头部损伤的发生率很高。这些损伤可能会因危及生命的颅内血肿的形成而变得复杂。必须提出明确的入院选择标准，以确保有效的观察。在我们收治的489例急诊时格拉斯哥昏迷量表（GCS）评分为15分的住院患者中：4例需要清除颅内血肿，11例需要修复凹陷性颅骨骨折或前颅窝底复合骨折。采用詹尼特及其同事提出的以颅骨骨折的存在作为入院选择标准，有可能将住院患者数量减少70%，同时又不会遗漏任何发生颅内血肿的患者。遵循这些标准，我们GCS评分为15分的患者中不会遗漏任何颅内血肿。我们建议，使用普通X线片来识别颅骨骨折并随后住院，可防止遗漏颅内血肿。那些意识水平下降或有局灶性神经功能缺损的患者，无论是否有颅骨骨折，都需要入院治疗。
