Haydel Micelle
Associate Clinical Professor, Residency Program Director, Section of Emergency Medicine, Louisiana State University Health Science Center, New Orleans, LA, USA.
Emerg Med Pract. 2012 Sep;14(9):1-24. Epub 2012 Jul 20.
With over 1.7 million people in the United States seeking medical attention for head injury each year, emergency clinicians are challenged daily to screen quickly for the small subset of patients who harbor a potentially lethal intracranial lesion while minimizing excessive cost, unnecessary diagnostic testing, radiation exposure, and admissions. Whether working at a small, rural hospital or a large inner-city public hospital, emergency clinicians play a critical role in the diagnosis and management of mild traumatic brain injury. This review assesses the burgeoning research in the field and reviews current clinical guidelines and decision rules on mild traumatic brain injury, addressing the concept of serial examinations to identify clinically significant intracranial injury, the approach to pediatric and elderly patients, and the management of patients who are on anticoagulants or antiplatelet agents or have bleeding disorders. The evidence on sports-related concussion and postconcussive syndrome is reviewed, and tools for assessments and discharge are included.
在美国，每年有超过170万人因头部受伤寻求医疗救治，急诊临床医生每天都面临着挑战，要快速筛查出一小部分患有潜在致命性颅内病变的患者，同时尽量降低成本、减少不必要的诊断检测、辐射暴露和住院率。无论是在小型乡村医院还是大型市中心公立医院工作，急诊临床医生在轻度创伤性脑损伤的诊断和管理中都发挥着关键作用。本综述评估了该领域迅速发展的研究，并回顾了关于轻度创伤性脑损伤的当前临床指南和决策规则，涉及通过系列检查来识别具有临床意义的颅内损伤的概念、针对儿科和老年患者的方法，以及对抗凝剂或抗血小板药物使用者或有出血性疾病患者的管理。还对与运动相关的脑震荡和脑震荡后综合征的证据进行了综述，并纳入了评估和出院工具。
