Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1620, New York, NY 10029, USA.
Psychiatr Clin North Am. 2010 Dec;33(4):797-806. doi: 10.1016/j.psc.2010.09.004.
The definition of a mild traumatic brain injury (TBI) has come under close scrutiny and is changing as a result of refined diagnostic testing. Although up to 15% of patients with a mild TBI will have an acute intracranial lesion identified on head computed tomography (CT), less than 1% of these patients will have a lesion requiring a neurosurgical intervention. Evidence-based guideline methodology has assisted in generating recommendations to facilitate clinical decision making; however, no set of guidelines is 100% sensitive and specific. Evidence supports the safety of discharging patients with mild TBI who have a negative CT. However, though patients with a negative CT are at almost no risk of deteriorating from a neurosurgical lesion, a key intervention is to provide these patients at discharge from the emergency department with counseling regarding postconcussive symptoms, when to return to work, school, or sports, and when to seek additional medical care.
轻度创伤性脑损伤 (TBI) 的定义受到了密切关注，并随着更精确的诊断测试而发生变化。尽管多达 15%的轻度 TBI 患者在头部计算机断层扫描 (CT) 上会发现急性颅内病变，但这些患者中只有不到 1%需要神经外科干预。循证指南方法有助于制定建议以促进临床决策；然而，没有一套指南是 100%敏感和特异的。证据支持对 CT 阴性的轻度 TBI 患者进行安全出院。然而，尽管 CT 阴性的患者从神经外科病变恶化的风险几乎为零，但关键的干预措施是在急诊科为这些患者出院时提供有关脑震荡后症状、何时返回工作、学校或运动以及何时寻求额外医疗护理的咨询。
