Department of Medicine, Denver Health, and University of Colorado School of Medicine, Denver, CO, USA.
Acad Emerg Med. 2012 Sep;19(9):E1055-60. doi: 10.1111/j.1553-2712.2012.01437.x.
The objectives of this study were to determine, in patients admitted to the hospital from the emergency department (ED) without evidence of trauma, 1) the prevalence of clinically important abnormalities on cranial computed tomography (CCT) and 2) the frequency of emergent therapeutic interventions required because of these abnormalities.
The authors retrospectively reviewed the records of all patients from 2007 between the ages of 18 and 89 years who had CCT as part of their ED evaluations prior to hospitalization. Patients with any indication of trauma were excluded, as were those who had a lumbar puncture (LP). Chief complaint, results of the ED neurologic examination, tomogram findings, and whether patients had emergent interventions were recorded. Patients presenting with altered mental status (AMS) were analyzed separately.
Of the 766 patients meeting inclusion criteria, 83 (11%) had focal neurologic findings, and 61 (8%) had clinically important abnormalities on computed tomography. Emergent interventions occurred in only 12 (1.6%), 11 (92%) of whom had focal neurologic findings. In the subgroup of 287 patients with AMS as their presenting problem, 14 (4.9%) had focal findings, six (2%) had clinically important abnormalities on tomography, and only two (0.7%) required emergent interventions, both of whom had focal findings. Patients presenting with AMS were less likely to have positive findings on tomography (odds ratio [OR] = 0.16, 95% confidence interval [CI] = 0.07 to 0.39). Patients presenting with motor weakness or speech abnormalities, or who were unresponsive, were more likely to have positive findings on tomography (OR = 4.7, 95% CI = 2.6 to 8.6; OR = 4.4, 95% CI = 1.5 to 2.7; and OR = 3.3, 95% CI = 1.6 to 7.1, respectively).
Of patients without evidence of trauma who receive CCT in the ED, the prevalence of focal neurologic findings and clinically important abnormalities on tomography is low, the need for emergent intervention is very low, and the large majority of patients requiring emergent intervention have focal findings. The yield of CCT was lower for patients presenting with AMS, and higher for patients presenting with motor weakness or speech abnormalities, and for those who were unresponsive.
本研究旨在确定从急诊科（ED）住院的无创伤证据的患者中，1）颅计算机断层扫描（CCT）上存在临床显著异常的发生率，2）因这些异常需要紧急治疗干预的频率。
作者回顾性分析了 2007 年间所有年龄在 18 至 89 岁之间的患者的记录，这些患者在住院前的 ED 评估中进行了 CCT。排除有任何创伤迹象的患者和接受腰椎穿刺（LP）的患者。记录主要症状、ED 神经检查结果、断层扫描结果以及患者是否接受紧急干预。对出现意识改变（AMS）的患者进行了单独分析。
在符合纳入标准的 766 名患者中，83 名（11%）有局灶性神经体征，61 名（8%）在 CT 上有临床显著异常。仅 12 名（1.6%）患者接受了紧急干预，其中 11 名（92%）有局灶性神经体征。在以 AMS 为首发症状的 287 名患者亚组中，14 名（4.9%）有局灶性体征，6 名（2%）在 CT 上有临床显著异常，只有 2 名（0.7%）需要紧急干预，两者均有局灶性体征。以 AMS 为首发症状的患者在 CT 上出现阳性结果的可能性较低（比值比[OR] = 0.16，95%置信区间[CI] = 0.07 至 0.39）。以运动无力或言语异常或无反应为首发症状的患者在 CT 上出现阳性结果的可能性更高（OR = 4.7，95% CI = 2.6 至 8.6；OR = 4.4，95% CI = 1.5 至 2.7；OR = 3.3，95% CI = 1.6 至 7.1）。
在急诊科接受 CT 检查且无创伤证据的患者中，局灶性神经体征和 CT 上存在临床显著异常的发生率较低，紧急干预的需求非常低，且需要紧急干预的大多数患者均有局灶性体征。以 AMS 为首发症状的患者 CCT 的检出率较低，而以运动无力或言语异常，或无反应为首发症状的患者的检出率较高。
