Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.
Scand J Trauma Resusc Emerg Med. 2012 Sep 4;20:62. doi: 10.1186/1757-7241-20-62.
This study prospectively assesses clinical characteristics and management of consecutive minimal, mild and moderate head injury patients referred for CT scans. Compliance with the Scandinavian head injury guidelines and possible reasons for non-compliance is explored.
From January 16th 2006 to January 15th 2007, 1325 computed tomography (CT) examinations due to minimal, mild or moderate head injury according to the Head Injury Severity Scale (HISS) were carried out at our University Hospital. When ordering a CT scan due to head trauma, physicians were asked to fill out a questionnaire.
Guideline compliance was impossible to assess in 49.5% of all cases. This was due to non-assessable or missing key variables necessary in the decision making algorithm. One or more key variables for HISS classification were not assessable in 34.4% as it was unknown whether there had been loss of consciousness (LOC), duration of LOC was unknown or it was impossible to assess amnesia or focal neurologic deficits. Definite compliance with both CT and admittance recommendations in guidelines was seen in only 31.2%. In 54.2% of patients with minimal head injuries who underwent CT scans, imaging was not necessary according to guidelines. 59.1% of all patients were admitted to hospital, however only 23.7% of these were admitted because of the head-injury alone. Age < 4 years, possible medical cause of injuries, severe headache/nausea or vomiting and the presence of non-traumatic CT findings were independently associated with non-assessable compliance with Scandinavian guidelines. Suspicion of influence of alcohol was inversely associated to non-compliance.
Despite the prospective study design, guideline compliance was not assessable in nearly half of the patients. Patients with isolated head injuries and available and obtainable complete clinical information necessary for guideline-based decision making are not dominating in a head injury population.
本研究前瞻性评估了连续轻度、轻度和中度头部损伤患者的临床特征和管理，并对 CT 扫描的情况进行了评估。研究探索了遵从斯堪的纳维亚头部损伤指南的情况以及不遵从的可能原因。
2006 年 1 月 16 日至 2007 年 1 月 15 日，我院对 1325 例按头部损伤严重程度评分（HISS）分类为轻度、轻度和中度的头部损伤患者进行了 1325 次计算机断层扫描（CT）检查。当因头部外伤行 CT 扫描时，医生被要求填写一份问卷。
在所有病例中，49.5%的病例无法评估指南的遵从性。这是由于决策算法中需要的关键变量不可评估或缺失。由于不知道是否有过意识丧失（LOC）、LOC 持续时间未知或无法评估遗忘或局灶性神经功能缺损，34.4%的病例无法评估 HISS 分类的一个或多个关键变量。只有 31.2%的患者完全符合 CT 和入院建议的指南。54.2%行 CT 扫描的轻度头部损伤患者根据指南不需要进行影像学检查。所有患者中有 59.1%住院，但其中只有 23.7%因头部损伤而住院。年龄＜4 岁、损伤可能有医学原因、严重头痛/恶心或呕吐以及存在非创伤性 CT 发现与不能评估斯堪的纳维亚指南的遵从性独立相关。怀疑有酒精影响与不遵从性呈负相关。
尽管采用了前瞻性研究设计，但仍有近一半的患者无法评估指南的遵从性。在头部损伤人群中，没有孤立性头部损伤患者，也没有可用的和可获得的用于基于指南决策的完整临床信息。
