John Walsh Centre for Rehabilitation Research, Kolling Medical Research Institute, Sydney Medical School, University of Sydney, Sydney, Australia.
Department of Psychology, Macquarie University, Sydney, Australia.
BMJ Open. 2017 Aug 4;7(8):e016222. doi: 10.1136/bmjopen-2017-016222.
Previous literature confirms that a mild traumatic brain injury (mTBI) may result in long-term emotional impacts and, in vulnerable subgroups, cognitive deficits. The accurate diagnosis of mTBI and its written documentation is an important first step towards providing appropriate and timely clinical care. Surveillance studies involving emergency department (ED) and hospital-based data need to be prioritised as these provide incident mTBI estimates. This project will advance existing research findings by estimating the occurrence of mTBI among those attending an ED and quantifying the accuracy of mTBI diagnoses recorded by ED staff through a comprehensive audit of ED records.
Retrospective chart reviews (between June 2015 and June 2016) of electronic clinical records from an ED in Sydney (New South Wales, Australia) will be conducted. The study population will include persons aged 18-65 years who attended the ED with any clinical features potentially indicative of mTBI. The WHO operational criteria for the clinical identification of mTBI cases is the presence of: (1) a Glasgow Coma Scale (GCS) of 13-15 after 30 min postinjury or on presentation to hospital; (2) one or more of the following: post-traumatic amnesia (PTA) of less than 24 hours' duration, confusion or disorientation, a witnessed loss of consciousness for ≤30 min and/or a positive CT brain scan. We estimate that 30 000 ED attendances will be screened and that a sample size of 500 cases with mTBI will be identified during this 1-year period, which will provide reliable estimates of mTBI occurrence in the ED setting.
The study was approved by the Northern Sydney Local Health District Ethics Committee. The committee deemed this study as low risk in terms of ethical issues. The written papers from this study will be submitted for publication in quality peer-reviewed medical and health journals. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journals.
既往文献证实，轻度创伤性脑损伤（mTBI）可能导致长期的情绪影响，在易受影响的亚组中，还可能导致认知缺陷。mTBI 的准确诊断及其书面记录是提供适当和及时临床护理的重要第一步。需要优先进行涉及急诊科（ED）和医院数据的监测研究，因为这些研究提供了 mTBI 的发生率估计。该项目将通过对 ED 记录进行全面审核，来估算 ED 就诊者中 mTBI 的发生率，并量化 ED 工作人员记录的 mTBI 诊断的准确性，从而推进现有研究结果。
对澳大利亚新南威尔士州悉尼市 ED 的电子临床记录进行回顾性图表审查（2015 年 6 月至 2016 年 6 月）。研究人群将包括年龄在 18-65 岁之间，因任何可能提示 mTBI 的临床特征而就诊 ED 的患者。WHO 用于临床识别 mTBI 病例的操作性标准为：（1）伤后 30 分钟或入院时格拉斯哥昏迷量表（GCS）评分为 13-15；（2）以下一种或多种情况：创伤后遗忘症（PTA）持续时间少于 24 小时、意识模糊或定向障碍、目击者意识丧失时间≤30 分钟和/或 CT 脑扫描阳性。我们估计将对 30000 次 ED 就诊进行筛查，在这 1 年期间将确定 500 例 mTBI 病例的样本量，这将为 ED 环境中 mTBI 的发生率提供可靠估计。
该研究已获得北悉尼地方卫生区伦理委员会的批准。委员会认为，从伦理角度来看，这项研究风险较低。本研究的书面论文将提交给高质量的同行评议医学和健康期刊发表。研究结果将通过在全国/国际会议和同行评议期刊上的演讲进行传播。
