成人轻型颅脑外伤的高危因素分析

The high risk factors of intracranial injuries in adult minor head Injury

目的 探讨成人轻型颅脑外伤（minor head injury,MHI）的高危因素。方法 对1395例符合纳入标准〔年龄≥18岁,头颅外伤后24h以内,格拉斯哥昏迷评分（glasgow coma scale,GCS）为13~15分MHI〕的患者进行前瞻性研究,以临床指标作为自变量,以CT显示的急性颅脑损伤结果作为因变量,采用logistic回归分析不同因素对于颅脑损伤的危险程度,并分析OR值较高的自变量与MHI的相关性。结果 与MHI高度相关的临床指标是：神经查体阳性、意识丧失、呕吐、头痛,GCS评分为13分。用这五项临床指标组合预测MHI的敏感度为77.9%,特异度为78.3%,阳性预测值为36.8%,阴性预测值为95.6%。结论 通过前瞻性临床研究,我们提出成人MHI颅内损伤的高危因素,此结果可为临床医师对患者伤情判断及治疗提供参考依据。

Objective To investigate the high risk factors of intracranial injuries in adult minor head injury（MHI）. Methods We adopted prospective study on 1395 adult patients of MHI who had 13- 15 scores of Glasgow Coma Scale （GCS） and aged over 18 within 24 hours after head injury. In our study, we tested the relationship between the clinical findings as independent variable and positive results on CT as dependent variable by logistic regression and compared the high risk factors via computing odds ratio （OR）. Then, we analyzed correlation of the higher independent variable and MHI. Results The high risk factors of brain trauma in adult MHI were neurological deficit, loss of consciousness, vomiting, headache, and GCS= 13. The sensitivity, specificity, positive predicitive value and negative predictive value of predicting MHI were 77.9%, 78.3 %, 36.8 and 95.6% respectively by the five high risk factors. Conclusion We come up with the high risk factors as markers to evaluate severity of adult MHI, which can help clinicians to make decision on the state of head injury and the proper treatment.