Zellner Tobias, Wegscheider Felix, Dommasch Michael, Eyer Florian, Dieminger Rebecca, Schmoll Sabrina
Division of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany.
Central Interdisciplinary Emergency Department, TUM School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany.
J Clin Med. 2024 Nov 24;13(23):7096. doi: 10.3390/jcm13237096.
Patients with recreational drug and ethanol poisoning often present with reduced consciousness, coma, or disorientation. It is often unclear if there was recent head trauma. Algorithms to perform cranial computed tomography (cCT) like the Canadian CT Head Rule (CCHR), the National Emergency X-Radiography Utilization Study Head CT Decision Instrument (NEXUS DI), or the New Orleans Criteria (NOC) exist for patients with head trauma. It is unclear whether these algorithms can be applied to this patient collective. This is a retrospective data analysis of patients admitted to our emergency department with drug or ethanol poisoning in 2019. Minors < 16 years were excluded. The primary outcome was fracture/bleeding in cCT, the secondary outcome was neurosurgical intervention. These results were calculated: 1. Sensitivity and negative predictive value (NPV) of the CCHR, NEXUS DI, and NOC. 2. Uni- and multivariate analysis of risk factors for critical findings. 3. The Munich cCT Rule sensitivity and NPV. A total of 420 patients were included. cCT was performed in 120 patients. Eight patients had fracture/bleeding in cCT, two required neurosurgical intervention. The number of patients at risk, sensitivity, and NPV for critical cCT findings were as follows: CCHR 57/25%/98.3%, NEXUS DI 239/100%/100%, NOC 420/100%/100%. The sensitivity and NPV for neurosurgical intervention were as follows: CCHR 50%/99.7%, NEXUS DI 100%/100%, NOC 100%/100%. In univariate analysis, these findings correlated significantly with the following critical findings: accident, injury, injury above clavicle, head wound, anisocoria, ethanol in serum > 2 g/L, hypotension, drug ingestion, GCS < 8, focal neurological deficit, age > 60, and cerebellar symptoms. Via chi-square recursive partitioning analysis, we created the Munich cCT Rule which is positive for intoxicated patients if both an accident and an ethanol level > 2 g/L are present. This identified 70 patients at risk. It excluded fracture/bleeding and neurosurgical intervention with a sensitivity and NPV of 100%. Fracture/bleeding in cCT in intoxicated patients is rare. Performing unnecessary cCTs should be avoided. The Munich cCT Rule for patients with recreational drug and ethanol poisoning may help rule out critical findings and is superior to the NEXUS DI and NOC. It also has a 100% sensitivity which the CCHR (25%) is lacking.
使用消遣性药物和乙醇中毒的患者常表现为意识减退、昏迷或定向障碍。通常不清楚近期是否有头部外伤。对于头部外伤患者，存在如加拿大头部CT规则（CCHR）、国家急诊X线摄影利用研究头部CT决策工具（NEXUS DI）或新奥尔良标准（NOC）等用于进行头颅计算机断层扫描（cCT）的算法。尚不清楚这些算法是否可应用于该患者群体。这是一项对2019年因药物或乙醇中毒入住我院急诊科患者的回顾性数据分析。排除了年龄＜16岁的未成年人。主要结局是cCT检查中的骨折/出血，次要结局是神经外科干预。计算了以下结果：1. CCHR、NEXUS DI和NOC的敏感性和阴性预测值（NPV）。2. 关键检查结果危险因素的单因素和多因素分析。3. 慕尼黑cCT规则的敏感性和NPV。共纳入420例患者。120例患者进行了cCT检查。8例患者cCT检查中有骨折/出血，2例需要神经外科干预。cCT关键检查结果的风险患者数量、敏感性和NPV如下：CCHR为57/25%/98.3%，NEXUS DI为239/100%/100%，NOC为420/100%/100%。神经外科干预的敏感性和NPV如下：CCHR为50%/99.7%，NEXUS DI为100%/100%，NOC为100%/100%。在单因素分析中，这些检查结果与以下关键检查结果显著相关：事故、损伤、锁骨以上损伤、头部伤口、瞳孔不等大、血清乙醇＞2 g/L、低血压、药物摄入、格拉斯哥昏迷量表（GCS）＜8、局灶性神经功能缺损、年龄＞60岁以及小脑症状。通过卡方递归划分分析，我们创建了慕尼黑cCT规则，对于中毒患者，如果同时存在事故和乙醇水平＞2 g/L则该规则为阳性。这确定了70例有风险的患者。它排除了骨折/出血和神经外科干预，敏感性和NPV均为100%。中毒患者cCT检查中的骨折/出血很少见。应避免进行不必要的cCT检查。用于消遣性药物和乙醇中毒患者的慕尼黑cCT规则可能有助于排除关键检查结果，且优于NEXUS DI和NOC。它还具有100%的敏感性，而CCHR为25%，不具备这一敏感性。
