Zyśko Dorota, Sutton Richard, Timler Dariusz, Furtan Stanisław, Melander Olle, Fedorowski Artur
Department of Medical Emer gency, Wroclaw Medical University, Wroclaw, Poland.
Cardiol J. 2014;21(6):674-8. doi: 10.5603/CJ.2014.0099.
Head trauma may present as transient loss of consciousness (TLOC) currently classified as traumatic in origin, in contrast to non-traumatic forms, such as syncope. Whether past history of syncope predisposes to loss of consciousness after head injury has been poorly studied.
A retrospective analysis of data obtained from 818 consecutive patients admitted to Emergency Departments was conducted. Face-to-face semi-structured interviews were performed, where patients' past history of syncope and head injury were explored. Head injury events were stratified as high- or low-energy trauma. Data regarding past syncopal events were explored in regard to number, age at the first occurrence, and syncope circumstances. Multivariate logistic regression model was applied to assess the relationship between loss of consciousness during head injury and past history of syncope.
Both past history of non-traumatic TLOC (odds ratio [OR] 3.78; 95% confidence interval [CI] 2.13-6.68, p < 0.001) and high-energy mechanism (OR 3.84; 95% CI 2.35-6.28, p < 0.001) predicted TLOC after head trauma. This relationship was even stronger when past episodes of TLOC were limited to those typical for reflex syncope (OR 4.34; 95% CI 2.34-7.89, p < 0.001). Further, the number of non-traumatic TLOC episodes in the patient's history was also predictive of TLOC after head injury (OR per 1 episode: 1.24; 95% CI 1.04-1.48, p = 0.015).
Syncope in a patient's history predicts loss of consciousness after head injury. The clinical importance of this finding merits further investigation.
头部创伤可能表现为短暂意识丧失（TLOC），目前归类为创伤性起源，与非创伤性形式如晕厥形成对比。晕厥的既往史是否会使头部受伤后更易发生意识丧失，这方面的研究较少。
对急诊科连续收治的818例患者的数据进行回顾性分析。进行面对面的半结构化访谈，探究患者晕厥和头部受伤的既往史。将头部受伤事件分为高能量或低能量创伤。就非创伤性晕厥事件的数量、首次发生年龄和晕厥情况进行了探究。应用多因素逻辑回归模型评估头部受伤期间意识丧失与晕厥既往史之间的关系。
非创伤性TLOC的既往史（比值比[OR] 3.78；95%置信区间[CI] 2.13 - 6.68，p < 0.001）和高能量机制（OR 3.84；95% CI 2.35 - 6.28，p < 0.001）均预测头部创伤后会发生TLOC。当既往TLOC发作仅限于反射性晕厥典型发作时，这种关系更强（OR 4.34；95% CI 2.34 - 7.89，p < 0.001）。此外，患者病史中非创伤性TLOC发作的次数也可预测头部受伤后的TLOC（每发作1次的OR：1.24；95% CI 1.04 - 1.48，p = 0.015）。
患者病史中的晕厥可预测头部受伤后的意识丧失。这一发现的临床重要性值得进一步研究。
