美国急诊医师学会关于成人轻度头部创伤患者脑部计算机断层扫描的建议：一项诊断准确性研究。
ACEP's Recommendations for Brain Computed Tomography Scan in Adult Minor Head Trauma Patients; a Diagnostic Accuracy Study.
作者信息
Mohammaddoust Mohammad, Mohammad Jafari Chokan Niaz, MoshirianFarahi SeyedehMaryam, Tavakolian Ayoub, Foroughian Mahdi
机构信息
Mohammad Mohammaddoust, MD: Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Niaz-Mohammad Jafari Chokan, MD: Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
出版信息
Arch Acad Emerg Med. 2020 Oct 29;8(1):e86. eCollection 2020.
INTRODUCTION
Some clinical decision rules have been developed to identify minor head trauma (MHT) patients in need of brain computed tomography (CT) scan for detection of possible traumatic brain injuries (TBIs). This study aimed to evaluate the performance of American College of Emergency Physicians (ACEP) recommendations in this regard.
METHODS
This study is a cross-sectional study of MHT (GCS: 13-15) cases who referred to emergency department of a level one trauma center, Mashhad, Iran, from October 2017 to March 2018. The screening performance characteristics of ACEP recommendations for performing brain CT scan in these patients were calculated.
RESULTS
500 patients with a mean age of 37.97 ± 15.96 years were evaluated. Based on level one recommendations, 73 (14.6 %) patients had to be assessed by brain CT scan. 67 (91.8%) were assessed and 6 (8.2%) were not assessed based on decision of their in-charge physician. According to level two recommendations, 125 (25.0%) patients did not need brain CT scan, 85 (68%) of whom had been assessed (all normal). Performing brain CT scan according to the level one recommendation of ACEP's clinical policy showed 29.6% sensitivity (95% CI: 13.75 to 50.18) and 86.3% specificity (95% CI: 82.68 to 89.14). The overall ACEP's clinical policy for neuroimaging of adults with MTBI showed sensitivity and specificity of 92.59% (95% CI: 75.71 to 99.09) and 26.4% (95% CI: 22.51 to 30.65), respectively.
CONCLUSION
ACEP's clinical policy has a high-level sensitivity for using brain CT scan in detection of probable TBI in patients with MHT.
引言
已制定了一些临床决策规则，以识别需要进行脑部计算机断层扫描（CT）以检测可能的创伤性脑损伤（TBI）的轻度头部创伤（MHT）患者。本研究旨在评估美国急诊医师学会（ACEP）在这方面建议的性能。
方法
本研究是一项对2017年10月至2018年3月转诊至伊朗马什哈德一级创伤中心急诊科的MHT（格拉斯哥昏迷评分：13 - 15）病例的横断面研究。计算了ACEP关于对这些患者进行脑部CT扫描建议的筛查性能特征。
结果
对500名平均年龄为37.97±15.96岁的患者进行了评估。根据一级建议，73名（14.6%）患者必须接受脑部CT扫描评估。根据其主管医生的决定，67名（91.8%）患者接受了评估，6名（8.2%）患者未接受评估。根据二级建议，125名（25.0%）患者不需要脑部CT扫描，其中85名（68%）患者已接受评估（全部正常）。根据ACEP临床政策的一级建议进行脑部CT扫描显示敏感性为29.6%（95%置信区间：13.75至50.18），特异性为86.3%（95%置信区间：82.68至89.14）。ACEP关于MTBI成人神经影像学的总体临床政策显示敏感性和特异性分别为92.59%（95%置信区间：75.71至99.09）和26.4%（95%置信区间：22.51至30.65）。
结论
ACEP的临床政策在使用脑部CT扫描检测MHT患者可能的TBI方面具有较高的敏感性。
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