Wade D T, King N S, Wenden F J, Crawford S, Caldwell F E
Rivermead Rehabilitation Centre, Oxford, UK.
J Neurol Neurosurg Psychiatry. 1998 Aug;65(2):177-83. doi: 10.1136/jnnp.65.2.177.
To confirm that patients admitted to hospital with a head injury benefit from a routinely offered early intervention service.
A mixed rural and urban Health District of 560000 people with two accident and emergency departments provided the setting. Existing routine services for most patients with head injury are minimal. All patients aged 16-65 years admitted to hospital after a head injury of any severity, with or without other injuries entered the trial. Prospective randomisation, with a block randomisation procedure was used to allocate all eligible patients to either: a group offered an additional service by a specialist team; or a group receiving existing standard services. Patients were assessed at follow up six months after injury. The primary outcome measure was the Rivermead head injury follow up questionnaire, a validated and reliable measure of social disability. The Rivermead post-concussion symptoms questionnaire was used to estimate severity of post-concussion symptoms. Each patient in the trial group was contacted 7-10 days after injury, and offered assessment and interventions as needed. These initially focused on the provision of information, support, and advice. Forty six per cent of patients in the trial group also received further outpatient intervention or additional support by telephone.
314 patients were registered: 184 were randomised into the trial group, 130 into the control group. For prognostic data, the groups were comparable at randomisation, and remained comparable when assessed at six months. 132 trial and 86 control patients were followed up at six months after injury. Patients' posttraumatic amnesia ranged from mild (n=79, 40%), and moderate (n=62, 32%), to severe (n=38, 19%) and very severe (n=17, 9%). The trial group patients had significantly less social disability (p=0.01) and significantly less severe post-concussion symptoms (p=0.02) at follow up at six months after injury than the control group patients.
The early interventions offered by a specialist service significantly reduced social morbidity and severity of post-concussion symptoms in trial group patients at six months after head injury. Recommendations about how specialist services should be targeted are made both in the light of these results and those from a previous randomised controlled trial.
证实因头部受伤入院的患者能从常规提供的早期干预服务中获益。
研究背景为一个拥有56万人口的城乡混合卫生区，区内设有两个急诊科。大多数头部受伤患者现有的常规服务极少。所有16至65岁因任何严重程度的头部受伤入院的患者，无论有无其他损伤，均纳入试验。采用前瞻性随机分组，通过区组随机化程序将所有符合条件的患者分为两组：一组由专科团队提供额外服务；另一组接受现有的标准服务。在受伤后六个月进行随访评估。主要结局指标是Rivermead头部损伤随访问卷，这是一种经过验证且可靠的社会残疾测量方法。Rivermead脑震荡后症状问卷用于评估脑震荡后症状的严重程度。试验组的每位患者在受伤后7至10天被联系，并根据需要提供评估和干预。最初这些主要集中在提供信息、支持和建议。试验组46%的患者还接受了进一步的门诊干预或通过电话获得额外支持。
登记了314例患者：184例被随机分配到试验组，130例被分配到对照组。就预后数据而言，两组在随机分组时具有可比性，在六个月评估时仍具有可比性。受伤后六个月对132例试验组患者和86例对照组患者进行了随访。患者的创伤后遗忘症程度从轻度（n = 79，40%）、中度（n = 62，32%）到重度（n = 38，19%）和极重度（n = 17，9%）不等。受伤后六个月随访时，试验组患者的社会残疾程度明显更低（p = 0.01），脑震荡后症状的严重程度也明显更低（p = 0.02）。
专科服务提供的早期干预在头部受伤后六个月时显著降低了试验组患者的社会发病率和脑震荡后症状的严重程度。根据这些结果以及之前一项随机对照试验的结果，对专科服务的目标定位提出了建议。
