Gorman D F
Accident and Emergency Department, Chester Royal Infirmary, England.
Arch Emerg Med. 1987 Sep;4(3):141-50. doi: 10.1136/emj.4.3.141.
During two 12-month periods, 12,395 accident and emergency department attenders with head injury were collected. Those characteristics which were significantly more common in head-injured patients who had skull fractures on X-ray were identified. These characteristics were: recent alcohol consumption in adults, initial unconsciousness, amnesia of any duration, vomiting, neurological signs, injuries sustained by pedestrians, motorcyclists and cyclists. Such characteristics were then further examined and their power as diagnostic tests for the presence of skull fracture on X-ray was detailed. In individual patients and especially in children, these characteristics were generally of little value in identifying patients with fractures. It was considered that, in the majority of individual patients with head injuries, accurate clinical diagnosis of radiologically apparent fractures was not possible. In view of this and in the light of the known risks in patients with fractures, it was concluded that skull X-rays should continue to be used relatively freely in the management of these patients.
在两个为期12个月的时间段内，收集了12395名因头部受伤到急诊科就诊的患者。确定了那些在X线检查显示有颅骨骨折的头部受伤患者中明显更常见的特征。这些特征包括：成人近期饮酒、初始意识丧失、任何时长的失忆、呕吐、神经体征、行人、摩托车手和骑自行车者所受的损伤。然后对这些特征进行了进一步检查，并详细说明了它们作为X线检查颅骨骨折存在与否的诊断测试的效能。在个体患者尤其是儿童中，这些特征在识别骨折患者方面通常价值不大。据认为，在大多数头部受伤的个体患者中，对放射学上明显的骨折进行准确的临床诊断是不可能的。鉴于此，并考虑到骨折患者的已知风险，得出的结论是，在这些患者的管理中应继续相对自由地使用颅骨X线检查。
