Department of Emergency Medicine, Inselspital, Bern, Switzerland.
Emerg Med J. 2010 Jul;27(7):537-9. doi: 10.1136/emj.2009.073031. Epub 2010 Apr 1.
Traumatic brain injury is one of the most common reasons for admission to hospital emergency departments. However, optimal diagnosis and treatment protocols remain controversial. The aim of this study is to assess whether a specific group of patients can be discharged from the hospital without 24-h neurological observation.
Retrospective analysis was performed for 1078 patients with a minor isolated head injury admitted to the authors' Emergency Department for 24-h observation. Exclusion criteria included intracranial bleeds with maximum diameter above 5 mm or multiple (>1) bleeds, a history of inherited coagulopathy or anticoagulant therapy, platelet aggregation inhibitor therapy, intoxication or multiple associated injuries. Furthermore, patients who had no-one to observe them at home or who lived more than 1 h away were excluded from the study.
110 patients presented with an isolated small intracranial bleed (<5 mm) with a Glasgow Coma Scale (GCS) of 13-15. Of these patients, 46% exhibited small intracerebral haematomas, 23% traumatic subarachnoid haematomas, 9% epidural haematomas and 7% subdural haematomas. Nine patients presented with a GCS of 13/15, 30 patients with a GCS 14/15 and 71 patients with a GCS 15/15. 85% of all patients regained GCS 15/15 within 1 h after admission and 15% within 2 h after admission. All patients maintained their GCS 15/15 over the 24-h period.
Standard 24-h observation may not be required for adult patients with single intracranial bleeds with maximum diameter less than 5 mm, without a history of inherited coagulopathy or anticoagulant therapy, platelet aggregation inhibitor therapy, intoxication or multiple associated injuries. The decision for discharging patients may be made from the clinical picture. This might help to spare hospital resources and reduce unnecessary hospitalisations.
颅脑创伤是导致患者前往医院急诊科就诊的最常见原因之一。然而，目前仍缺乏最佳的诊断和治疗方案。本研究旨在评估特定人群是否可以在不接受 24 小时神经观察的情况下出院。
对作者所在急诊科收治的 1078 例单纯性轻度头部损伤患者进行回顾性分析。排除标准包括最大直径大于 5 毫米或多处（>1 处）出血的颅内出血、遗传性凝血功能障碍或抗凝治疗史、血小板聚集抑制剂治疗史、中毒或多处合并伤。此外，排除无人在家观察或居住地距离医院超过 1 小时的患者。
110 例患者表现为孤立性小颅内出血（<5 毫米），格拉斯哥昏迷评分（GCS）为 13-15 分。这些患者中，46%存在小脑出血，23%存在外伤性蛛网膜下腔出血，9%存在硬膜外血肿，7%存在硬膜下血肿。9 例患者 GCS 为 13/15，30 例患者 GCS 为 14/15，71 例患者 GCS 为 15/15。所有患者在入院后 1 小时内，85%恢复至 GCS 15/15，15%在入院后 2 小时内恢复。所有患者在 24 小时内均保持 GCS 15/15。
对于无遗传性凝血功能障碍或抗凝治疗史、血小板聚集抑制剂治疗史、中毒或多处合并伤，最大直径小于 5 毫米的单发性颅内出血、无上述病史的成年患者，标准的 24 小时观察可能并非必需。根据临床表现即可决定患者是否可以出院。这有助于节省医院资源并减少不必要的住院。
