頭部外傷電腦斷層掃瞄處理準則在偏遠地區醫院之運用

Application of the Brain CT-Scan Guidelines for Head Injury Management in a Rural Hospital

謝清水(Ching-Shui Hsieh) ； 吳尚蓉(Shang-Jung Wu) ； 李智貴(Chih-Kuei Lee) ； 源嘉鳳(Chia-Feng Yuan) ； 陳慶咪(Khing-Mee Tan) ； 余鴻彰(Hung-Chang Yu) ； 王瑜(Yu Wang) ； 施炳源(Ping-Yuan Shih) ； 趙文崇(Wun-Tsong Chaou)

《中華民國急救加護醫學會雜誌》 19卷4期 (2008/12) Pp. 139-145

https://doi.org/10.30018/JECCM.200812.0001

摘要

目的：回顧偏遠地區急診科運用頭部外傷悲者處理準則的結果與臨床意義。
方法：以立意取樣收集此地區一年七個月间，某地區醫院急診科的頭部外傷病人，依台灣神經外科醫學會研訂的處理準則接受腦部電腦斷層攝影檢查(CT)的192位病人為研究對象，做回頫性病例分析。
結果：頭部外傷之研究樣本以男性居多(66.7%)；年齡40-60歲為主(29.7%)；交通意外(57.3%)為最常見的創傷機轉；腦部CT呈陽性共65位(33.9%)。年齡與腦部CT陽性人數成顯著正相關。昏迷指數15分的150位病患中，無神經症狀（如噁心、嘔吐、意識短暫喪失等症狀）者共14人，其中腦部CT陽性人數有10人(71.4%)，明顯較高於有症狀者的陽性率(21.3%)。昏迷指數則與CT陽性呈顯著負相關。昏迷指數15時，CT陽性率仍高達26%。
結論：由於地處偏遠交通及轉診不便，輕度頭部外傷患者雖昏迷指數為正常，仍應小心評估觀察。昏迷指數越低，腦部CT陽性比率越高，對意識不清病人即使無神經症狀，仍需考慮腦部電腦斷層攝影檢查。
方法：以立意取樣收集此地區一年七個月問，某地區醫院急診科的頭部外傷病人，依台灣神經外科醫學會研訂的處理準則接受腦部電腦斷層攝影檢查(CT)的192位病人為研究對象，做回頫性病例分析。
結果：頭部外傷之研究樣本以男性居多(66.7%)；年齡40-60歲為主(29.7%)；交通意外(57.3%)為最常見的創傷機轉；腦部CT呈陽性共65位(33.9%)。年齡與腦部CT陽性人數成顯著正相關。昏迷指數15分的150位病患中，無神經症狀（如嗯心、嘔吐、意識短暫喪夫等症狀）者共14人，其中腦部CT陽性人數有10人(71.4%)，明顯較高於有症狀者的陽性率(21.3%)。昏迷指數則與CT陽性呈顯著負相關。昏迷指數15時，CT陽性率仍高達26%。
結論：由於地處偏遠交通及轉診不便，輕度頭部外傷患者雖昏迷指數為正常，仍應小心評估觀察。昏迷指數越低，腦部CT陽性比率越高，對意識不清病人即使無神經症狀，仍需考慮腦部電腦斷層攝影檢查。

關鍵字

電腦斷層攝影 ； 頭部外傷 ； 處理準則 ； 偏遠地區

並列摘要

Object: To assess the application in a rural community hospital of the head CT scan guidelines proposed by the Taiwan Neurosurgical Society (TNS) for the management of head injury.
Method: The study period was 19 months and consisted of a retrospective analysis of the medical records of 192 patients who had suffered various seventies of head injury and had undergone a CT scan at the emergency department of a rural community hospital.
Results: Traffic accidents were the major cause of head injury in the sample. Most were male (66.7%) and most were aged from 40 years to 64 years (29.7%). Overall, 65 (33.9%) cases were found to have abnormal CT scan findings. Older patients showed a greater tend towards having abnormal CT findings. Yet among 150 patients with a normal coma scale score, the absence of neurological symptoms, such as nausea, vomiting and transient loss of consciousness, was associated with a higher rate of positive CT findings (71.4%). Furthermore, the lower the Glasgow Coma Scale (GC’S) score of the patient, the more likely they were to have an abnormal CT finding. Overall, 26% of patients with a normal coma scale score (GCS=15) were found to have abnormal CT scan findings.
Conclusions: Physicians in emergency departments in rural areas should assess more cautiously head injury patients with normal GCS scores. A brain CT scan should he considered in head injury patients with consciousness disturbance even though they have no neurological symptoms. A cautious explanation to the patient and their family is suggested if a neurosurgeon is not readily available.

並列關鍵字

computerized tomography ； head injury ； practice guideline ； rural area