Sartin Rebecca, Kim Christine, Dissanaike Sharmila
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Am J Surg. 2017 Dec;214(6):1055-1058. doi: 10.1016/j.amjsurg.2017.07.038. Epub 2017 Sep 18.
Despite the development of several prediction rules to guide head CT imaging, determining whom to screen for head trauma in the geriatric population after a ground level fall remains controversial. The purpose of this study was to assess the impact of head CT on the management of older adult patients who present with a normal GCS after a ground level fall, and to identify factors that could predict the need for neurosurgical intervention.
A retrospective study was conducted on hemodynamically stable patients >55 years of age with GCS of 15, who presented to a level 1 trauma center after a ground level fall. Radiological reads of head CT scans were reviewed for new findings and clinical documentation was analyzed for evidence of a change in management. Univariate analysis of key demographic and clinical factors was performed to probe for statistically significant differences between patients receiving medical management versus surgical management.
Of 437 patients receiving head CTs, 146 (33.4%) had a positive finding. 95 (21.7%) patients had a change in management; 76 (17.4%) were medication changes and 19 (4.3%) required neurosurgical intervention. Age 85 years and older, and having a neurologic deficit on initial physical examination were found to be significantly associated with the need for neurosurgery.
The results of this study confirm that head CT findings often alter clinical management of elderly patients presenting with a GCS of 15 after ground level falls, and should be a part of standard evaluation.
尽管已经制定了多种预测规则来指导头部CT成像，但对于在平地跌倒后的老年人群中筛选头部创伤患者的对象仍存在争议。本研究的目的是评估头部CT对平地跌倒后格拉斯哥昏迷量表（GCS）正常的老年患者治疗管理的影响，并确定可预测神经外科干预需求的因素。
对年龄>55岁、GCS评分为15分且血流动力学稳定、平地跌倒后就诊于一级创伤中心的患者进行回顾性研究。对头部CT扫描的影像学报告进行复查以发现新的结果，并对临床记录进行分析以寻找治疗管理改变的证据。对关键的人口统计学和临床因素进行单因素分析，以探究接受药物治疗与手术治疗的患者之间的统计学显著差异。
在接受头部CT检查的437例患者中，146例（33.4%）有阳性发现。95例（21.7%）患者的治疗管理发生了改变；76例（17.4%）是药物治疗的改变，19例（4.3%）需要神经外科干预。发现85岁及以上年龄以及初次体格检查时有神经功能缺损与神经外科手术需求显著相关。
本研究结果证实，头部CT检查结果常常会改变平地跌倒后GCS评分为15分的老年患者的临床治疗管理，应成为标准评估的一部分。
