精神状态改变患者计算机断层扫描异常结果的临床预测因素。

Clinical predictors of abnormal computed tomography findings in patients with altered mental status.

作者信息

Lim B L, Lim G H, Heng W J, Seow E

机构信息

Emergency Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.

出版信息

Singapore Med J. 2009 Sep;50(9):885-8.

PMID:19787177

Abstract

INTRODUCTION

While non-contrast computed tomography (CT) of the brain can be used to rapidly identify patients with altered mental status (AMS) in the emergency department (ED), with an acute intracranial bleed or infarct, a wide variation in its use exists. The aim of this pilot study was to identify the clinical predictors of an abnormal CT result in ED patients with AMS.

METHODS

We conducted a retrospective study of patients aged 15 years and older presenting with undifferentiated AMS in a busy urban ED over one year. Data collected included demographical, clinical, laboratory and radiological features. The primary outcome of interest was the presence of an abnormal CT result defined as an acute infarct or intracranial bleed. Secondary outcomes were clinical predictors of an abnormal CT result. The data was analysed using descriptive statistics. Logistic regression was used to identify clinical predictors of an abnormal CT result. Odds ratios (ORs) were reported with 95 percent confidence intervals (CIs).

RESULTS

578 patients were recruited, of which 284 (49.1 percent) were males. 327 (56.6 percent) patients underwent CT of the brain. 128 scans (39.1 percent) were abnormal. Logistic regression revealed seven clinical features that were associated with an abnormal CT result. They were mean age greater than or equal to 73 years (OR 1.03; 95 percent CI 1.015-1.045), drowsiness or unresponsiveness (OR 1.73; 95 percent CI 0.17-17.72), previous cerebrovascular accident (OR 2.03; 95 percent CI 0.82-5.02), previous epilepsy (OR 1.63; 95 percent CI 0.63-4.19), tachycardia [greater than 120/min] (OR 1.16; 95 percent CI 0.38-3.54), bradycardia [less than 60/min] (OR 1.35; 95 percent CI 0.19-9.59) and exposure to drugs (OR 1.90; 95 percent CI 0.58-6.26).

CONCLUSION

We identified seven clinical predictors of an abnormal CT result in AMS patients. Future research in prospective studies is needed to validate these findings.

摘要

引言

虽然脑部非增强计算机断层扫描（CT）可用于在急诊科（ED）快速识别精神状态改变（AMS）的患者，以确定是否存在急性颅内出血或梗死，但在其使用方面存在很大差异。这项初步研究的目的是确定急诊科AMS患者CT结果异常的临床预测因素。

方法

我们对一家繁忙的城市急诊科中15岁及以上出现未分化AMS的患者进行了为期一年的回顾性研究。收集的数据包括人口统计学、临床、实验室和放射学特征。感兴趣的主要结局是CT结果异常，定义为急性梗死或颅内出血。次要结局是CT结果异常的临床预测因素。使用描述性统计分析数据。采用逻辑回归分析来确定CT结果异常的临床预测因素。报告比值比（OR）及其95%置信区间（CI）。

结果

共招募了578名患者，其中284名（49.1%）为男性。327名（56.6%）患者接受了脑部CT检查。128次扫描（39.1%）结果异常。逻辑回归分析显示有七个临床特征与CT结果异常相关。它们分别是平均年龄大于或等于73岁（OR 为1.03；95%CI 为1.015 - 1.045）、嗜睡或无反应（OR 为1.73；95%CI 为0.17 - 17.72）、既往脑血管意外（OR 为2.03；95%CI 为0.82 - 5.02）、既往癫痫（OR 为1.63；95%CI 为0.63 - 4.19）、心动过速[大于120次/分钟]（OR 为1.16；95%CI 为0.38 - 3.54）、心动过缓[小于60次/分钟]（OR 为1.35；95%CI 为0.19 - 9.59）以及药物暴露（OR 为1.90；95%CI 为0.58 - 6.26）。