轻微头部外伤后头部CT扫描对神经外科手术的预测

摘要

Objective: There continues to be an ongoing debate regarding the utility of Head CT scans in patients with a normal Glasgow Coma Scale (GCS) after minor head injury.The objective of this study is to determine patient and injury characteristics that predict a positive head CT scan or need for a Neurosurgical Procedure (NSP) among patients with blunt head injury and a normal GCS. Methods:Retrospective analysis of adult patients with a history of blunt head injury and a normal GCS,the primary outcomes were a positive head CT scan or a NSP.Multivariate logistic regression controlling for patient and injury characteristics was used to determine predictors of each outcome.Results:Total of 835 patients,250 (29.9%) had a positive head CT scan and 38 (9.9%)underwent a NSP.Older patients and patients with a history of fall (as compared to a motor vehicle crash) were more likely to have a positive finding on a head CT scan.Male patients,and those who presented with a fall were more likely to have a NSP.Conclusion:Older age,male gender,and mechanism of injury are significant predictors of a positive finding on head CT scans and the need for neurosurgical procedures.This study highlights patient and injury specific characteristics that may help in identifying patients with supposedly minor head injury who will benefit from a head CT scan.%目的：本研究的目的是确定钝性颅脑损伤及正常格拉斯哥昏迷评分（GCS）患者采用头部CT扫描预测采取神经手术操作（Neurosurgical Procedure，NSP）的必要。方法：回顾分析钝性颅脑损伤成人患者的临床资料，主要结局为阳性头部CT扫描或NSP。采用多变量回归分析分析损伤特征确定预测因素。结果：835例患者中，250例（29.9%）头部CT阳性，38例（9.9%）经历NSP。年龄更大及跌倒史患者（与效能事故比较）CT阳性的可能性更大。男性跌倒患者更可能经历NSP。结论：年龄较大，男性的性别、损伤的机制是头部CT扫描阳性和需要神经外科程序的重要预测指标。这项研究表明，患者年龄和损伤的具体特点可帮助确定那些可能受益于头部CT扫描的轻微颅脑患者。