Davis R L, Mullen N, Makela M, Taylor J A, Cohen W, Rivara F P
Department of Pediatrics, University of Washington, Seattle.
Ann Emerg Med. 1994 Oct;24(4):640-5. doi: 10.1016/s0196-0644(94)70273-x.
To assess the need for cranial computed tomography (CT) in the emergency department evaluation of children with Glasgow Coma Scale (GCS) score of 15 after mild head injury with loss of consciousness.
Retrospective case series of children aged 2 to 17 years with documented loss of consciousness after head injury from January 1, 1988, to July 31, 1992. All had a GCS score of 15 on initial ED evaluation and were further categorized according to physical examination findings, neurologic status, and whether the head injury was isolated or nonisolated. Recursive partitioning was used to identify variables predictive of the presence and absence of intracranial hemorrhage.
ED in two settings: a regional tertiary care trauma center and a community children's hospital.
Of the 185 patients who met study criteria, 17 had evidence of depressed or basilar skull fractures on physical examination or had a ventriculoperitoneal shunt in place before head injury. In the remaining 168 patients, recursive partitioning identified two variables (neurologic status and head injury type) associated with intracranial hemorrhage. Overall, 12 of 168 patients (7%) had intracranial bleeding. However, none of the 49 neurologically normal children with isolated head injury had intracranial hemorrhage (95% confidence interval, 0.0 to 6.0).
The prevalence of intracranial hemorrhage in children with mild closed-head injury appears to vary with the presence of neurologic abnormalities and other noncranial injuries. After isolated head injury with loss of consciousness, children older than 2 years who are neurologically normal and without signs of depressed or basilar skull fracture may be discharged home from the ED without a cranial CT scan after careful physical examination alone.
评估在急诊科对格拉斯哥昏迷量表（GCS）评分为15分的轻度头部受伤且伴有意识丧失的儿童进行头颅计算机断层扫描（CT）的必要性。
对1988年1月1日至1992年7月31日期间有头部受伤后意识丧失记录的2至17岁儿童进行回顾性病例系列研究。所有患儿在急诊科初始评估时GCS评分为15分，并根据体格检查结果、神经状态以及头部损伤是单纯性还是非单纯性进一步分类。采用递归分割法确定预测颅内出血存在与否的变量。
两个机构的急诊科：一个地区三级创伤中心和一家社区儿童医院。
在符合研究标准的185例患者中，17例在体格检查时有颅骨凹陷或颅底骨折的证据，或在头部受伤前已行脑室腹腔分流术。在其余168例患者中，递归分割法确定了与颅内出血相关的两个变量（神经状态和头部损伤类型）。总体而言，168例患者中有12例（7%）发生颅内出血。然而，49例单纯头部受伤且神经状态正常的儿童均无颅内出血（95%置信区间，0.0至6.0）。
轻度闭合性头部损伤儿童颅内出血的发生率似乎因神经异常和其他非颅脑损伤的存在而有所不同。在单纯头部受伤且伴有意识丧失后，2岁以上神经状态正常且无颅骨凹陷或颅底骨折体征的儿童，在仅经过仔细的体格检查后，可从急诊科出院，无需进行头颅CT扫描。
