Reinus W R, Wippold F J, Erickson K K
Department of Radiology, Jewish Hospital, Washington University Medical Center, St Louis, Missouri.
Ann Emerg Med. 1993 Jul;22(7):1148-55. doi: 10.1016/s0196-0644(05)80981-3.
To study patients with acute trauma retrospectively for clinical predictors of positive cranial computed tomography.
We reviewed the medical records and noncontrast computed tomography scans of 373 consecutive head trauma patients presenting to a trauma Level I emergency department. Potential criteria for patient selection were analyzed statistically, using both univariate and multivariate models.
Our data suggest that relying on four variables--positive neurologic examination, intoxication, and a history of amnesia or focal neurologic deficit--as screening criteria for computed tomography would have saved 58.6% of the scans performed on these patients. Together, these criteria had a sensitivity of 90.1% and a negative predictive value of 98.1% for abnormal computed tomography. Four patients with positive scans would not have been detected using this strategy. None of these patients deteriorated clinically or required operative intervention.
Our data suggest that it may be possible to effectively screen patients with head trauma for cranial computed tomography using clinical criteria and so reduce the current number of scans performed by more than half. However, a prospective study is required to confirm our results.
对急性创伤患者进行回顾性研究，以寻找头颅计算机断层扫描（CT）结果呈阳性的临床预测指标。
我们回顾了连续373例就诊于一级创伤急诊科的头部创伤患者的病历和非增强CT扫描结果。使用单变量和多变量模型对潜在的患者选择标准进行统计学分析。
我们的数据表明，将四项指标——神经系统检查阳性、中毒、失忆史或局灶性神经功能缺损——作为CT扫描的筛选标准，可减少这些患者58.6%的扫描次数。综合来看，这些标准对CT异常的敏感性为90.1%，阴性预测值为98.1%。采用该策略会漏诊4例CT扫描结果呈阳性的患者。这些患者均未出现临床病情恶化，也无需手术干预。
我们的数据表明，或许可以利用临床标准对头部创伤患者进行有效的CT扫描筛选，从而将目前的扫描次数减少一半以上。然而，需要进行前瞻性研究来证实我们的结果。
