重型颅脑创伤合并多发伤漏诊分析

Strategies of preventing missed diagnosis of severe traumatic brain injuries combined with multiple trauma

目的探讨重型、持重型颅脑创伤伴有多发伤漏诊规律和防治策略。方法收集2000年1月-2007年8月收治的432例符合重型、特重型颅脑创伤合并多发伤（ISS≥20分）诊断标准患者的临床资料并对其进行回顾性分析，将其分为漏诊组和无漏诊组，对ISS、GCS、漏诊的部位、时间、预后进行相关性分析。结果432例患者中有54例漏诊，ISS为（42．97±10．94）分，与无漏诊组比较，差异有统计学意义（P〈0．05）。漏诊组GCS≤8分的患者比例高于非漏诊组（P〈0．05）。结论迅速准确的程序化伤情判断、贯穿生命第一原则的全面体检、重点辅查及动态复查是防止漏诊、提高重型颅创伤合并多发伤生存率并减少致残率的有效措施，

Objective To investigate the strategies of reducing the incidence of missed diagnosis of severe traumatic brain injuries combined with multiple trauma. Methods Data of 432 patients with severe traumatic brain injuries and multiple trauma （ISS ≥20 ） from January 2000 to August 2007 were analyzed retrospectively. All patients were divided into missed diagnosis group （MD group, n = 54） and non-missed diagnosis group （ NMD group, n = 378 ） for correlation analysis on ISS, GCS, anatomical locations of the missed diagnosis, the time of delayed diagnosis and the prognosis. Results ISS was （42.97 ±10.94 ） points in MD group, with statistical difference compared with NMD group （P 〈 0.05 ）. The patients with GCS ≤ 8 in MD group was more than those in NMD group （ P 〈 0.05 ）. Conclusions It is effective to prevent missed diagnosis and improve the survival of patients with severe traumatic brain injuries combined with multiple trauma by judging injury severity quickly and precisely based on the principle of ＂life first＂ and repeated and systemic physical examination.