Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Emergency Medicine, China Medical University Hospital, Hsinchu, Taiwan.
J Emerg Med. 2020 Jul;59(1):46-52. doi: 10.1016/j.jemermed.2020.04.037. Epub 2020 May 26.
Stimulant poisoning frequently causes altered mental status (AMS) and can result in severe cerebral vascular complications. The role of noncontrast brain computed tomography (CT) in acute stimulant-poisoned patients presenting with AMS remains unclear.
We examined the results and impacts of brain CT in acute stimulant-poisoned patients with AMS.
We performed a retrospective single-center study that included all adult patients who presented to the emergency department with stimulant poisoning and AMS (Glasgow coma scale [GCS] score <15) between January 1, 2010 and December 31, 2017. Patients who had concomitant head trauma or who presented with focal neurologic symptoms were excluded. The primary outcome was the rate of acute abnormalities on brain CT. The secondary outcomes were to identify factors that affected the decision to perform brain CT in stimulant-poisoned patients with AMS and whether obtaining the brain CT scan itself affected the patients' prognoses.
The analysis included 66 patients, of whom 6 died from the poisoning. Noncontrast brain CT was performed in 31 patients and none had acute abnormalities. Patients who underwent brain CT were found to have worse GCS scores, higher body temperatures, higher intubation rates, higher admission rates, longer admission periods and intensive care unit stays, and a higher mortality rate. After adjusting for the propensity score, performing brain CT itself did not independently affect the patients' clinical outcomes.
Nontrauma stimulant-poisoned patients presenting with AMS and without focal neurologic symptoms were unlikely to have acute abnormalities on brain CT. Patients who underwent brain CT scans had worse consciousness and greater disease severity.
兴奋剂中毒常导致意识状态改变，并可导致严重的脑血管并发症。在出现意识状态改变（AMS）的急性兴奋剂中毒患者中，非增强脑计算机断层扫描（CT）的作用仍不清楚。
我们研究了急性兴奋剂中毒伴 AMS 患者脑 CT 的结果和影响。
我们进行了一项回顾性单中心研究，纳入了 2010 年 1 月 1 日至 2017 年 12 月 31 日期间因急性兴奋剂中毒和 AMS（格拉斯哥昏迷量表[GCS]评分<15）就诊于急诊科的所有成年患者。排除合并头部外伤或出现局灶性神经症状的患者。主要结局是脑 CT 上急性异常的发生率。次要结局是确定影响急性兴奋剂中毒伴 AMS 患者行脑 CT 的因素，以及获取脑 CT 扫描本身是否影响患者的预后。
分析纳入了 66 例患者，其中 6 例因中毒死亡。31 例行非增强脑 CT 检查，均未见急性异常。行脑 CT 检查的患者 GCS 评分较低、体温较高、气管插管率较高、入院率较高、住院时间和 ICU 停留时间较长、死亡率较高。在调整倾向评分后，行脑 CT 本身并不独立影响患者的临床结局。
无创伤性兴奋剂中毒伴 AMS 且无局灶性神经症状的患者，脑 CT 上不太可能有急性异常。行脑 CT 扫描的患者意识状态较差，疾病严重程度较高。
