Pôle Médecine d'Urgence - Place du Dr Joseph Baylac, CHU Toulouse, Toulouse, 31300, France.
Université Paul Sabatier Toulouse III, Toulouse, France.
BMC Emerg Med. 2024 Oct 29;24(1):207. doi: 10.1186/s12873-024-01124-5.
Head injuries are the leading cause of trauma in Emergency Departments (EDs). Recent studies have shown epidemiological changes in patients consulting ED for head injuries. The main objective of this study was to describe the profile of head injury patients consulting in the EDs in France and assess i) head injury severity across age groups; ii) the delay between the occurrence of head injury and ED arrival; iii) factors associated with traumatic intracranial hemorrhage (ICH).
This cross-sectional study collected patient data over a three-day period in March 2023. All adult patients (≥ 18 years old) admitted to the ED with a head injury (defined as a trauma to the head) were included. TBI severity was classified according to patients' initial Glasgow Coma Scale score in the ED: severe (3-8); moderate (9 -12); mild (13-15); and simple head trauma in the absence of transient or persistent neurological symptoms.
Among the 71 participating EDs, 26,008 patients visited EDs and a total of 1070 patients (4.1%, IC 95 3.9-4.4) presented a head injury were included in the study, with a median age of 68.5 [37-85] years old. Most of the patients (66.7%) were referred to ED after a call to the Emergency Medical Dispatcher (EMD). The median time from head injury to ED visit was 2 h [1.0 - 5.5]. Ground-level falls were the leading cause of head injury (60.3%). Most of patient presented a simple head trauma (n = 715, 66.8%) followed by mild TBI (n = 337, 31.5%). CT head scans were performed for 636 patients (59.6%), of which 58 were positive. Traumatic ICH prevalence was 5.4% (95% CI: 4.1-6.9) and three patients (0.3%) required an urgent neurosurgical intervention. Neither preinjury anticoagulant (p = 0.97) nor antiplatelet (p = 0.93) use was associated with an increased risk of traumatic ICH.
One head injury patient out of two presenting in the ED is aged over 65 years. Patients referred by EMD were more likely to visit ED promptly. The majority of older patients underwent a head CT scan and preinjury anticoagulant use was not associated with increased risk of traumatic ICH.
头部损伤是急诊科（ED）创伤的主要原因。最近的研究表明，因头部损伤到 ED 就诊的患者的流行病学特征发生了变化。本研究的主要目的是描述在法国 ED 就诊的头部损伤患者的特征，并评估：i）各年龄段的头部损伤严重程度；ii）头部损伤与 ED 就诊之间的时间延迟；iii）与创伤性颅内出血（ICH）相关的因素。
这是一项在 2023 年 3 月为期三天的时间内收集患者数据的横断面研究。所有因头部外伤（定义为头部外伤）而被收治到 ED 的成年患者（≥18 岁）均被纳入研究。根据患者在 ED 的初始格拉斯哥昏迷量表评分，将 TBI 严重程度分类：严重（3-8 分）；中度（9-12 分）；轻度（13-15 分）；以及单纯头部外伤且无短暂或持续性神经症状。
在参与的 71 个 ED 中，有 26,008 名患者到 ED 就诊，共有 1070 名（4.1%，95%CI：3.9-4.4）患者存在头部损伤，纳入研究的患者中位年龄为 68.5 [37-85] 岁。大多数患者（66.7%）是在呼叫急救医疗调度员（EMD）后被转至 ED。从头部损伤到 ED 就诊的中位时间为 2 小时[1.0-5.5]。平地跌倒为头部损伤的主要原因（60.3%）。大多数患者（n=715，66.8%）为单纯头部外伤，其次是轻度 TBI（n=337，31.5%）。对 636 名患者（59.6%）进行了头部 CT 扫描，其中 58 例为阳性。创伤性 ICH 的患病率为 5.4%（95%CI：4.1-6.9），3 名患者（0.3%）需要紧急神经外科干预。受伤前抗凝治疗（p=0.97）或抗血小板治疗（p=0.93）与创伤性 ICH 风险增加无关。
在 ED 就诊的每两名头部损伤患者中就有一名年龄超过 65 岁。由 EMD 转来的患者更有可能及时到 ED 就诊。大多数老年患者接受了头部 CT 扫描，受伤前抗凝治疗与创伤性 ICH 风险增加无关。
