Khalayleh H, Lin G, Kadar Sfarad H, Mostafa M, Abu Abed N, Imam A, Zbar A P, Mavor E
Department of General Surgery, Kaplan Medical Center (Affiliated to the School of Medicine, Hebrew University and Hadassah, Jerusalem), 76100, Rehovot, Israel.
World J Surg. 2019 Feb;43(2):497-503. doi: 10.1007/s00268-018-4821-5.
There is debate concerning the need for specialist neurosurgical transfer of patients presenting to Level II trauma centers with a minimal head injury (Glasgow Coma Scale ≥13) and a small non-progressive intracranial bleeding (ICB).
A retrospective chart analysis was performed assessing the outcomes of adult patients presenting with a minor traumatic ICB on initial CT scan (minimal subarachnoid hemorrhage; small-width subdural hematoma without shift; punctate cerebral contusion). Patients with extradural hematomas and those patients on antiplatelet or anticoagulant therapy were excluded from the protocol.
Overall 291 cases were assessed (mean age 69.9 years) with 75% of cases presenting after a fall. There was deterioration of neurological status in 11 patients (3.8%) with 8 hospital transfers and 5 with an abnormal neurological examination (NE). Two patients with an abnormal INR and a worsening head CT were transferred without neurosurgical intervention. Of the 8 transferred cases there were 2 deaths (both >90 years of age with multiple comorbidities) with one craniotomy performed for a subdural hematoma (with full recovery). Three patients meeting transfer criteria were not transferred with one death (patient >90 years of age with severe dementia). The remaining 2 patients were discharged with normal neurological outcomes.
Patients with a minimal traumatic brain injury and a non-progressive minor ICB may be safely managed in a Level II trauma center by an acute care consultant with neurosurgical consultation but without the need for neurosurgical transfer.
Retrospective analysis: Level IV.
对于轻度颅脑损伤（格拉斯哥昏迷量表≥13分）且颅内出血（ICB）较小且无进展的患者，是否需要专科神经外科转运至二级创伤中心存在争议。
进行回顾性病历分析，评估初次CT扫描显示轻度创伤性ICB的成年患者的结局（最小蛛网膜下腔出血；无移位的小宽度硬膜下血肿；点状脑挫伤）。硬膜外血肿患者以及接受抗血小板或抗凝治疗的患者被排除在该方案之外。
共评估了291例病例（平均年龄69.9岁），75%的病例为跌倒后就诊。11例患者（3.8%）神经功能状态恶化，其中8例转院，5例神经检查（NE）异常。2例国际标准化比值异常且头颅CT恶化的患者未经神经外科干预即被转院。在8例转院病例中，有2例死亡（均>90岁，合并多种疾病），其中1例因硬膜下血肿行开颅手术（完全康复）。3例符合转院标准的患者未转院，1例死亡（>90岁，重度痴呆患者）。其余2例患者出院时神经功能正常。
轻度创伤性脑损伤且非进展性轻度ICB的患者可在二级创伤中心由急性护理顾问进行安全管理，并接受神经外科会诊，但无需神经外科转运。
回顾性分析：四级。
