成人輕型顱腦外傷急診CT檢查評估規則應用的研究

A Study of the Application of Head CT Rules in Adult Patients with Mild Traumatic Brain Injury in the Emergency Room

目的初步探討急診科對成人輕型顱腦外傷進行選擇性CI檢查的可行性和適合本地的相關危險因素。方法對451例成人輕型顱腦外傷的危險因素和腦部CI檢查結果進行分析,檢驗15項危險因素對CI檢查結果的全域性統計學意義;檢驗1S項危險因素軍因素對CT檢查結果的統計學意義;檢驗應用腦部CI檢查評估規則對腦部CI檢查陽性率的影響。結果15項危險因素二項分類Logistic回歸分析,得到Scorex-93.786,P值為0.00,說明15項危險因素整體對腦部CT結果的影響,具有統計學意義;15項危險因素中年齡≥65歲.GCS<15分.神經系統缺失、短暫意識喪失.任何顱底骨折表現單因素分析的P值<0.05,對腦部CI檢查陽性結果的影響具有統計學意義;應用腦部CI檢查評估規則對腦部CI陽性率的影響沒有統計學意義,優勢比OR(奇數比)1.479倍。結論熟悉輕型顱腦外傷的危險因素,制定適合當地實際情況的,簡單、清晰、易於掌握和便於執行的腦部CI檢查規則,有助於指導磕床進行選擇性腦部CI檢查。

Objective To identify the local risk factors and investigate the feasibility of selective head CT in adult patients with mild traumatic brain injury(MTBI)in the emergency room.Methods e clinical data and head CT ndings from 451 adult patients with MTBI were involved in this study.We tested the predictive power of 15 risk factors using positive results on head CT,and to assess the feasibility of applying the head CT rules on the positive rate of head CT results.Results 15 risk factors were analyzed retrospectively using logistic regression analysis on the 2 categories. e result showed Scorex2=93.786,p value was 0.00. is suggested that the e ect of the 15 risk factors on head CT results as a whole was statistically signi cant.Among the 15 risk factor,age 65,GCS<15,neurological de cit,transient loss of consciousness,any signs suggesting basal skull fracture all showed P value<0.05,and thus have statistical signi cance. e application of the head CT rules has no statistical signi cance on the positive rate of head CT.Conclusion e signi cant risk factors of MTBI as listed above may serve as indications for head CT.A simple,clear,easy to master and execute head CT rule which suits the local situation can help clinicians to decide ordering head CT for patients with MTBI.