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轻微头部创伤患者CT的过度使用:来自波兰和立陶宛创伤中心的回顾性分析

Overuse of CT for Minor Head Trauma Patients: A Retrospective Analysis from Poland and Lithuania Trauma Centres.

作者信息

Blažienė Kristina, Nożewski Jakub, Cibulskė Vaida, Kunigonytė Monika, Košytė Deimantė, Bareikis Karolis, Aukštakalnis Vytautas

机构信息

Emergency Medicine Department, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.

Emergency Medicine Department, Jan Biziel University Hospital no 2, 85-168 Bydgoszcz, Poland.

出版信息

Medicina (Kaunas). 2024 Nov 21;60(12):1908. doi: 10.3390/medicina60121908.

Abstract

: Head trauma is one of many conditions that trauma centres deal with daily. This study aimed to analyse the utilisation of head CT scans for patients with minor head trauma in two major hospitals in Lithuania and Poland. : We conducted a retrospective, descriptive study of CT utilisation in minor head trauma patients presenting to the Level 1 trauma centre Hospital of the Lithuanian University of Health Sciences Kaunas Clinics (HLUHS KC) and Jan Biziel University Hospital in Bydgoszcz emergency departments (EDs), during the study period from 01 February to 30 April 2023. : During the study period, 1048 patients visited the HLUHS KC emergency department (ED) due to head trauma, and 388 patients visited the Jan Biziel University Hospital. Overall, 611 patients were included in the study. Most of the patients (92%) who suffered minimal trauma were younger than 65 years old. Eighty-two per cent of the patients older than 65 years old arrived at the ED after suffering a fall. Almost all the patients who were using antiplatelets (93%) or anticoagulants (91%) had CT scans. Non-emergency medicine (EM) physicians were more likely to order head CT scans than EM physicians (170 (83%) vs. 249 (62%), < 0.001). There were 33 (5%) CT scans with traumatic features, and 8 (1%) of these were categorised as clinically significant. Patients who suffered clinically significant head trauma were more likely to be on anticoagulants and older than 65 when compared to normal/insignificant CT findings: 3 (38%) vs. 25 (6%), < 0.001; and 6 (75%) vs. 146 (36%), < 0.021. : A significant number of head CT scans performed were not necessary according to existing head CT guidelines and risk calculators. However, even in minor head traumas, clinically significant head injuries may occur.

摘要

头部创伤是创伤中心日常处理的众多病症之一。本研究旨在分析立陶宛和波兰两家主要医院中轻度头部创伤患者的头部CT扫描使用情况。

我们对2023年2月1日至4月30日研究期间,前往立陶宛卫生科学大学考纳斯临床医院(HLUHS KC)一级创伤中心和比得哥什扬·比齐埃尔大学医院急诊科(ED)的轻度头部创伤患者的CT使用情况进行了回顾性描述性研究。

在研究期间,1048名患者因头部创伤前往HLUHS KC急诊科,388名患者前往扬·比齐埃尔大学医院。总体而言,611名患者被纳入研究。大多数受轻伤的患者(92%)年龄小于65岁。82%的65岁以上患者在跌倒后前往急诊科。几乎所有使用抗血小板药物(93%)或抗凝剂(91%)的患者都进行了CT扫描。非急诊医学(EM)医生比急诊医学医生更有可能开具头部CT扫描(170例(83%)对249例(62%),<0.001)。有33例(5%)CT扫描有创伤特征,其中8例(1%)被归类为具有临床意义。与正常/无意义的CT结果相比,遭受具有临床意义的头部创伤的患者更有可能使用抗凝剂且年龄大于65岁:3例(38%)对25例(6%),<0.001;6例(75%)对146例(36%),<0.021。

根据现有的头部CT指南和风险计算器,大量进行的头部CT扫描是不必要的。然而,即使在轻度头部创伤中,也可能发生具有临床意义的头部损伤。

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Mild head trauma in elderly patients: experience of an emergency department.老年患者的轻度头部创伤:急诊科的经验
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Mild brain injury and anticoagulants: Less is enough.轻度脑损伤与抗凝剂:用量越少越好。
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