Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
Ann Emerg Med. 2013 Dec;62(6):597-603. doi: 10.1016/j.annemergmed.2013.06.020. Epub 2013 Aug 2.
We determine the effect of the duration of emergency department (ED) observation on computed tomography (CT) rate for children with minor blunt head trauma.
We performed a prospective cohort study of children with blunt head trauma and a Glasgow Coma Scale score greater than 14. We defined time from injury as the time from head injury to initial physician (emergency attending physician or fellow) assessment. For children who were observed in the ED before CT decisionmaking, we defined ED observation time as time from initial physician assessment to the decision whether to obtain a CT. After adjusting for time from injury, patient age, sex, physician type, and study month, we measured the effect of ED observation time on CT rate in each of the 3 Pediatric Emergency Care Applied Research Network Traumatic Brain Injury risk groups.
Of the 1,605 eligible patients, we enrolled 1,381 (86%). Of the enrolled patients, 676 (49%) were observed in the ED and 272 (20%) had a CT performed. After adjustment, every hour of ED observation time was associated with a decrease in CT rate for children in all 3 traumatic brain injury risk groups: high risk (adjusted odds ratio [OR] 0.11; 95% confidence interval [CI] 0.05 to 0.24), intermediate risk (adjusted OR 0.28; 95% CI 0.21 to 0.36), and low risk (adjusted OR 0.47; 95% CI 0.31 to 0.73). All 8 children with a significant traumatic brain injury had an immediate CT.
For children with minor blunt head trauma, ED observation time was associated with a time-dependent reduction in cranial CT rate, with no delay in the diagnosis of a significant traumatic brain injury.
我们旨在确定急诊科（ED）观察时间的长短对轻微钝性头部创伤儿童进行计算机断层扫描（CT）的概率的影响。
我们对格拉斯哥昏迷量表评分大于 14 分的钝性头部创伤患儿进行了前瞻性队列研究。我们将受伤时间定义为从头部受伤到初始医生（急诊主治医生或研究员）评估的时间。对于在 CT 决策前在 ED 观察的儿童，我们将 ED 观察时间定义为从初始医生评估到决定是否进行 CT 的时间。在调整受伤时间、患者年龄、性别、医生类型和研究月份后，我们测量了 ED 观察时间对每个儿科急诊护理应用研究网络创伤性脑损伤风险组 CT 率的影响。
在 1605 名符合条件的患者中，我们纳入了 1381 名（86%）。在纳入的患者中，676 名（49%）在 ED 观察，272 名（20%）进行了 CT。调整后，ED 观察时间每增加 1 小时，所有 3 个创伤性脑损伤风险组的 CT 率均降低：高风险（调整后的优势比 [OR] 0.11；95%置信区间 [CI] 0.05 至 0.24）、中风险（调整后的 OR 0.28；95% CI 0.21 至 0.36）和低风险（调整后的 OR 0.47；95% CI 0.31 至 0.73）。所有 8 名有明显创伤性脑损伤的儿童均立即进行 CT 检查。
对于轻微钝性头部创伤的儿童，ED 观察时间与 CT 颅率呈时间依赖性降低相关，且无明显创伤性脑损伤的诊断延迟。
