Davis R L, Hughes M, Gubler K D, Waller P L, Rivara F P
Department of Pediatrics, University of Washington, Seattle 98195.
Pediatrics. 1995 Mar;95(3):345-9.
Recent evidence suggests that patients with a normal cranial CT scan after head injury can be safely discharged home from the emergency department. However, supporting data from previous studies has relied on incomplete patient follow-up. We utilized a statewide comprehensive hospital abstract reporting system (CHARS) to assess whether children with normal CT scans after head injury subsequently developed intracranial sequelae in the month following their initial injury.
Retrospective case-series study, with comprehensive statewide follow-up for 1 month.
The emergency department of a Level 1 Trauma Center in Seattle, Washington.
All children (n = 400) with head injury, Glasgow Coma Score of 13 to 15, and initial normal CT scan seen over a 4.5-year time period. All were matched against CHARS to evaluate admissions within 30 days after emergency department disposition. For readmissions, International Classification of Diseases (9th revision) discharge and procedure information was collected. All children were also matched against the state death files.
Four children were readmitted for neurologic reasons within 1 month following injury. One child on coumadin for heart disease developed a symptomatic subdural hematoma 5 days after head injury, requiring neurosurgical drainage. One child developed a symptomatic hemorrhagic contusion 3 days after injury, requiring observation only. Two children were readmitted 1 day after injury for concussive symptoms; both were discharged home after observation only. There were no deaths among the study population.
Among children with a normal cranial CT scan after mild head injury, delayed intracranial sequelae requiring intervention are extremely uncommon. In otherwise stable patients, a normal cranial CT scan can identify patients to be safely discharged from the emergency department, and would be more cost-effective than 1 to 2 days of hospital observation.
近期证据表明，头部受伤后头颅CT扫描正常的患者可从急诊科安全出院回家。然而，以往研究的支持数据依赖于不完整的患者随访。我们利用全州综合医院摘要报告系统（CHARS）来评估头部受伤后CT扫描正常的儿童在初次受伤后的一个月内是否会随后出现颅内后遗症。
回顾性病例系列研究，进行全州范围的综合随访1个月。
华盛顿州西雅图市一级创伤中心的急诊科。
在4.5年时间内就诊的所有头部受伤、格拉斯哥昏迷评分为13至15分且初次CT扫描正常的儿童（n = 400）。所有患者均与CHARS匹配，以评估急诊科处置后30天内的入院情况。对于再次入院患者，收集国际疾病分类（第9版）出院及诊疗信息。所有儿童还与州死亡档案进行匹配。
4名儿童在受伤后1个月内因神经原因再次入院。一名因心脏病服用华法林的儿童在头部受伤5天后出现有症状的硬膜下血肿，需要神经外科引流。一名儿童在受伤3天后出现有症状的出血性挫伤，仅需观察。两名儿童在受伤1天后因脑震荡症状再次入院；经观察后均出院回家。研究人群中无死亡病例。
在轻度头部受伤后头颅CT扫描正常的儿童中，需要干预的迟发性颅内后遗症极为罕见。在其他情况稳定的患者中，正常的头颅CT扫描可确定可从急诊科安全出院的患者，且比住院观察1至2天更具成本效益。
