Tan Tock Seng Hospital, Singapore, Singapore.
Eur J Emerg Med. 2013 Apr;20(2):86-90. doi: 10.1097/MEJ.0b013e328351e5f4.
The aim of this study was to determine the proportions of patients with a head injury and a Glasgow Coma Scale of 15 with an abnormal computed tomographic (CT) head scan and to explore its predictors.
We conducted a retrospective study on adult patients with such injuries. Patients were risk stratified to undergo a head CT and subsequently discharged or admitted to a neurosurgical (NS) intensive care unit (ICU)/high-dependency (HD) NS or general ward (GW) and observation ward [Emergency Diagnostic and Therapeutic Centre (EDTC)]. The primary outcomes were proportions of abnormal CT results and NS interventions. The secondary outcomes included rates of disposition status, and the distribution and predictors of abnormal CT results. Data were analysed using descriptive statistics. We identified predictors of an abnormal head CT using logistic regression and reported their odds ratios (ORs) and 95% confidence intervals.
We reviewed 2038 complete records. A total of 1088 scans were performed; 115 (10.6%) were abnormal. There were 962 (47.2%) discharges and 1076 (52.8%) admissions; six (0.6%) required NS interventions and ICU/HD admission. The proportions of GW admissions (n=1070) were as follows: EDTC 78.0%; NS 18.0%; and medical 4.0%. The proportions of abnormal CT results among these disposition statuses were as follows: NS ICU/HD 6/6 (100%); EDTC 59/835 (7.1%); NS GW 47/188 (25.0%); and medical GW 3/33 (9.1%). We identified three predictors, namely, vomiting [OR 2.23 (1.39-3.58)]; loss of consciousness [OR 1.56 (1.03-2.36)]; and amnesia [OR 2.08 (1.30-3.31)].
Abnormal CT and NS interventions were infrequent in patients with a head injury and a Glasgow Coma Scale of 15. We identified three predictors of abnormal head CTs.
本研究旨在确定格拉斯哥昏迷量表评分为 15 分的颅脑损伤患者中，行头颅 CT 检查结果异常的比例，并探讨其预测因素。
我们对颅脑损伤的成年患者进行了回顾性研究。患者根据风险分层行头颅 CT 检查，随后分为出院、转入神经外科（NS）重症监护病房（ICU）/高依赖（HD）NS 病房、转入普通病房（GW）和观察病房[急救诊断治疗中心（EDTC）]。主要结局为异常 CT 结果和 NS 干预的比例。次要结局包括处置状态的发生率，异常 CT 结果的分布和预测因素。数据采用描述性统计分析。我们采用逻辑回归分析确定异常头颅 CT 的预测因素，并报告其优势比（OR）和 95%置信区间（CI）。
我们回顾了 2038 份完整病历。共进行了 1088 次扫描，其中 115 次（10.6%）结果异常。出院 962 例（47.2%），入院 1076 例（52.8%），6 例（0.6%）需要 NS 干预和 ICU/HD 入院。GW 入院（n=1070）的分布如下：EDTC 78.0%；NS 18.0%；和内科 4.0%。这些处置状态的异常 CT 结果比例如下：NS ICU/HD 6/6（100%）；EDTC 59/835（7.1%）；NS GW 47/188（25.0%）；和内科 GW 3/33（9.1%）。我们确定了三个预测因素，即呕吐[OR 2.23（1.39-3.58）]；意识丧失[OR 1.56（1.03-2.36）]；和遗忘[OR 2.08（1.30-3.31）]。
格拉斯哥昏迷量表评分为 15 分的颅脑损伤患者中，异常 CT 和 NS 干预并不常见。我们确定了三个异常头颅 CT 的预测因素。
