Teasdale G, Galbraith S, Murray L, Ward P, Gentleman D, McKean M
Br Med J (Clin Res Ed). 1982 Dec 11;285(6356):1695-7. doi: 10.1136/bmj.285.6356.1695.
Deciding which head-injured patients should be transferred to a neurosurgical unit can be difficult. Traditional criteria emphasise the development of deteriorating responsiveness but lead to delayed diagnosis and to avoidable mortality and morbidity. To discover if a more liberal admission policy improved results a study was conducted analysing data collected prospectively from 683 patients who had a traumatic intracranial haematoma evacuated in the Glasgow neurosurgical unit between 1974 and 1980. In the first four years, before the change in policy, mortality was 38% but decreased to 29% afterwards. This reflected a reduction in the proportion of patients who talked after injury but who deteriorated into coma before operation--that is, 31% before the change in policy, 16% afterwards. If the potential benefits of CT scanning in the management of head injuries are to be realised patients must be scanned sooner than in the past. This will usually mean that more patients should go to a neurosurgical unit and that simple criteria for transfer should be established.
决定哪些头部受伤的患者应被转至神经外科病房并非易事。传统标准强调反应能力恶化的进展情况，但会导致诊断延迟以及可避免的死亡率和发病率。为了探究更为宽松的收治政策是否能改善治疗效果，开展了一项研究，分析了1974年至1980年间在格拉斯哥神经外科病房接受外伤性颅内血肿清除术的683例患者的前瞻性收集数据。在政策改变前的头四年，死亡率为38%，之后降至29%。这反映出受伤后能说话但在手术前陷入昏迷的患者比例有所下降——即政策改变前为31%，之后为16%。若要实现CT扫描在头部损伤管理中的潜在益处，患者必须比过去更早接受扫描。这通常意味着更多患者应前往神经外科病房，且应制定简单的转院标准。
