Bruns John J, Jagoda Andy S
Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA.
Mt Sinai J Med. 2009 Apr;76(2):129-37. doi: 10.1002/msj.20101.
Mild traumatic brain injury accounts for 1% to 2% of emergency department visits in the United States. Up to 15% of these patients will have an acute intracranial lesion identified on head computed tomography; less than 1% of mild traumatic brain injuries will require neurosurgical intervention. Clinical research over the past decade has focused on identifying the subgroup of patients with mild traumatic brain injury with acute traumatic lesions on computed tomography and specifically those at risk for harboring a potentially catastrophic lesion. This research has been used to generate evidence-based guidelines to assist in clinical decision making. There is no evidence to support the use of plain film radiographs in the evaluation of patients with mild traumatic brain injury. The utility of brain-specific biomarkers is rapidly evolving, and a growing body of evidence supports their potential role in determining the need for neuroimaging. Clinical predictors for identifying patients with abnormal computed tomography have been established and, if used, may have a significant positive impact on traumatic brain injury-related morbidity and healthcare utilization in the United States. Patients with negative computed tomography are at almost no risk of deteriorating; however, they should be counseled regarding postconcussive symptoms and should be given appropriate written instructions and referrals at discharge.
在美国，轻度创伤性脑损伤占急诊科就诊病例的1%至2%。这些患者中，高达15%的人在头部计算机断层扫描中会发现急性颅内病变；轻度创伤性脑损伤患者中，不到1%需要神经外科干预。过去十年的临床研究主要集中在识别计算机断层扫描显示有急性创伤性病变的轻度创伤性脑损伤患者亚组，特别是那些有潜在灾难性病变风险的患者。这项研究已被用于制定循证指南，以协助临床决策。没有证据支持在评估轻度创伤性脑损伤患者时使用普通X线平片。脑特异性生物标志物的效用正在迅速发展，越来越多的证据支持它们在确定是否需要神经影像学检查方面的潜在作用。已确定了用于识别计算机断层扫描异常患者的临床预测指标，如果使用这些指标，可能会对美国创伤性脑损伤相关的发病率和医疗保健利用产生重大积极影响。计算机断层扫描结果为阴性的患者几乎没有病情恶化的风险；然而，应就脑震荡后症状对他们进行咨询，并在出院时给予适当的书面指导和转诊建议。
