The Classification and Risk Factors of Mild Head Injury

輕度頭部外傷之分類及危險因子

紀煥庭(Huan-Ting Chi) ； 邱文達(Wen-Ta Chiu) ； 楊大羽(Dar-Yu Yang) ； 蔡行瀚(Shin-Han Tsai)

《Journal of Emergency Medicine, Taiwan》 9卷2期 (2007/06) Pp. 31-38

摘要

背景：探討目前對於輕度頭部外傷的定義，以昏迷指數Glasgow Coma Scale (GCS)大於13分以上做為分類是否恰當？
方法：利用回溯性的研究，在兩年期間共收集到GCS在13-15的輕度頭部外傷，總共4271人。探討其臨床表現並分析會增加顱內出血機會的危險因子。
結果：其中970人(22.7%)電腦斷層結果發現有顱內出血，334(7.8%)需接受開顱手術以及237人(5.5%)預後不佳。我們歸納出八項危險因子，包括：男性、入院時GCS不到15分、意識喪失、傷後失憶、痙攣、神經障礙、顱骨骨折、年紀大於65歲。
結論：傷患GCS在13-15之間，其實臨床的差異是蠻大的。當傷患的GCS是13或14時，通常比較容易有嚴重的傷害。目前的輕度頭部外傷的定義可能讓人產生錯誤的印象，甚至造成疏失；因為其實傷害的結果可能不是“輕度”。我們建議，應該將GCS 13-15的傷患再細分為“輕度頭部外傷”及“高危險群輕度頭部外傷”。“輕度頭部外傷”定義為GCS 15且電腦斷層正常；“高危險群輕度頭部外傷”定義為GCS13、14或15但電腦斷層異常者。

關鍵字

輕度頭部外傷 ； 昏迷指數 ； 危險因子

並列摘要

Aim: Evaluate the current definition of mild head injury and judge if GCS (Glasgow Coma Scale) 13 is a good critical value.
Methods: A retrospective study of 4271 patients with mild head injury (GCS score 13-15) during a 2-year period. Their clinical manifestations were analyzed statistically to find the risk factors of intracranial lesions, neurosurgical intervention and poor outcome.
Results: 970 (22.7%) patients had intracranial lesions proven by computed tomography (CT) of the head, 334 (7.8%) needed neurosurgical intervention and 237(5.5%) had an unfavorable outcome. Eight risk factors were found: male, GCS score lower than 15, initial loss of consciousness, post-traumatic amnesia, seizures, focal signs, presence of skull fractures, and old age (°Ÿ65).
Conclusion: We suggest that mild head injury is defined as a GCS score of 15 without acute radiographic abnormalities, whereas high-risk mild head injury is defined as a GCS score of 13 or 14, or a GCS score of 15 with acute radiographic abnormalities.

並列關鍵字

mild head injury ； Glasgow Coma Scale GCS ； risk factors