头部受伤后仍有意识患者头颅计算机断层扫描异常的临床预测因素

Clinical predictors of abnormal head computed tomography scan in patients who are conscious after head injury.

作者信息

Mishra Rakesh Kumar, Munivenkatappa Ashok, Prathyusha Vasuki, Shukla Dhaval P, Devi Bhagavatula Indira

机构信息

Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

National Institute of Epidemiology (ICMR), Chennai, Tamil Nadu, India.

出版信息

J Neurosci Rural Pract. 2017 Jan-Mar;8(1):64-67. doi: 10.4103/0976-3147.193538.

DOI:10.4103/0976-3147.193538

PMID:28149084

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5225725/

Abstract

BACKGROUND

Indication of a head computed tomography (CT) scan in a patient who remains conscious after head injury is controversial. We aimed to determine the clinical features that are most likely to be associated with abnormal CT scan in patients with a history of head injury, and who are conscious at the time of presentation to casualty.

MATERIALS AND METHODS

This is a prospective observation study of patients presented to casualty with history of head injury, and who were conscious, i.e., Glasgow Coma Scale (GCS) 15 at the time of evaluation. All patients underwent head CT scan. The CT scan was reported as abnormal if it showed any pathology ascribed to trauma. The following variables were used: age, gender, mode of injury (road traffic accident, fall, assault, and others), duration since injury, and history of transient loss of consciousness, headache, vomiting, ear/nose bleeding, and seizures. Logistic regression analysis was used to identify the clinical features that predicted an abnormal CT scan.

RESULTS

During the observation period, a total of 1629 patients with head injury were evaluated, out of which 453 were in GCS 15. Abnormal CT scan was present in 195 (43%) patients. Among all the variables, the following were found significantly associated with abnormal CT scan: duration since injury (>12 h) < 0.001; vomiting odds, ratio (OR) 1.89 (1.23, 2.80), < 0.001; and presence of any symptom, OR 2.36 (1.52, 3.71), < 0.001.

CONCLUSION

A patient with GCS 15 presenting after 12 hours of injury with vomiting or combination of symptoms has a significant risk of abnormal head CT scan.

摘要

背景

对于头部受伤后仍保持清醒的患者，是否进行头部计算机断层扫描（CT）存在争议。我们旨在确定在有头部受伤史且就诊时清醒的患者中，最有可能与CT扫描异常相关的临床特征。

材料与方法

这是一项对有头部受伤史且就诊时清醒（即评估时格拉斯哥昏迷量表[GCS]评分为15分）的患者进行的前瞻性观察研究。所有患者均接受头部CT扫描。如果CT扫描显示任何与创伤相关的病变，则报告为异常。使用了以下变量：年龄、性别、受伤方式（道路交通事故、跌倒、袭击及其他）、受伤后时长、短暂意识丧失史、头痛、呕吐、耳/鼻出血及癫痫发作史。采用逻辑回归分析来确定预测CT扫描异常的临床特征。

结果

在观察期内，共评估了1629例头部受伤患者，其中453例GCS评分为15分。195例（43%）患者CT扫描异常。在所有变量中，发现以下因素与CT扫描异常显著相关：受伤后时长（>12小时）<0.001；呕吐比值比（OR）为1.89（1.23，2.80），<0.001；存在任何症状，OR为2.36（1.52，3.71），<0.001。