Miller J D, Jones P A
Lancet. 1985 May 18;1(8438):1141-4. doi: 10.1016/s0140-6736(85)92442-0.
A survey was done of the workload involved in conducting a programme in which all degrees of severity of head injury are managed in one unit staffed by neurosurgeons. Of 1919 patients admitted to the unit in 1981, 93 were classed as severe (in coma), 210 as moderate, and 1616 as minor (fully conscious or confused only) on admission. Although the proportion of intracranial haematomas, multiple injuries, life-threatening complications, and deaths was highest in severe cases, the work of looking after the very large numbers of moderate and minor cases was as great as that of looking after severe cases as defined by number of investigations, operations, and complications, morbidity, and duration of hospital stay. In 1982 the admission policy was changed so that temporary loss of consciousness was no longer an indication for admission. This change resulted in a 24% reduction in number of admissions. Seat-belt legislation, enacted early in 1983, was followed by a further 21% reduction in the admission rate and this was maintained in 1984. Not all of this latter reduction can, however, be attributed to the wearing of seat belts.
针对一个由神经外科医生负责的、对各种严重程度的头部损伤进行治疗的项目所涉及的工作量进行了一项调查。1981年，该科室收治的1919名患者中，93名被归类为重伤（昏迷），210名中度受伤，1616名轻伤（入院时神志清醒或仅神志模糊）。虽然颅内血肿、多处受伤、危及生命的并发症及死亡的比例在重伤病例中最高，但从检查、手术、并发症的数量、发病率及住院时间来看，照顾大量中度和轻伤患者的工作量与照顾重伤患者的工作量一样大。1982年，入院政策发生了变化，即短暂意识丧失不再作为入院指征。这一变化使入院人数减少了24%。1983年初颁布了安全带法规，随后入院率又进一步降低了21%，且这一趋势在1984年得以维持。然而，后一次入院率的降低并非全部归因于安全带的使用。
