急診腦部電腦斷層是否為輕微頭部外傷患者的必要性檢查？南投某地區院的病醫例分享

Is Emergency Brain Computed Tomography Necessary for All Minor Head Trauma Patients? Cases Review from a Nantou Local Hospital

葉國球(Kuo-Chiu Yeh) ； 廖宏恩(Hung-En Liao) ； 曾清輝(Ching-Huei Tseng) ； 藍守仁(Shou-Jen Lan)

《安泰醫護雜誌》 17卷4期 (2011/12) Pp. 69-82

https://doi.org/10.7078/TSMHMNJN.201112.0069

摘要

目的：急診室頭部外傷的病人中，輕度的頭部外傷病人佔了絕大部份，此類病人可能甚至不用住院，在家觀察即可。此類病人是否應該都要立刻進行電腦斷層檢查，這就是急診醫師頭痛的問題。方法：本研究收集南投某地區醫院病歷資料，加以整理分析而成。依研究對象背景資料進行描述性統計，將年齡、性別、抵達急診方式、到院時間及急診檢傷分級級別列為研究變項，以Pearson相關分析、獨立樣本t檢定，及卡方檢定，檢定各變項與是否有安排電腦斷層施作之相關性，再以”是否有安排電腦斷層”為依變項，進行邏輯式迴歸分析。結果：從2010年1月１日至7月31日，總共收集急診輕度頭部外傷資料402筆，其中男生231人，女生171人，病人年齡最小1歲，最大102歲。402位病人中有328 (80.6%) 有被安排腦部電腦斷層的檢查。電腦斷層有異常發現的百分比為17.3%，住院病人有96位 (其中16位需嚴密觀察而進入加護病房)。在急診處，1位病人情况變化，緊急進入開刀房作開顱手術。結論：雖然只有一位病人需進行手術治療，但腦部電腦斷層發現異常的比率可達17.3% (含水腦症的病人)，加上現今醫糾問題不斷，所以只要符合醫療準則，腦部電腦斷層目前仍然是頭部外傷病人最好的檢查。

關鍵字

頭部外傷 ； 腦部電腦斷層 ； 急診檢傷分類

並列摘要

Objectives: The mildhead injuries, occupyingthe majority of traumatic patients, might not require hospitalization, but manage at home with observation. Once patients with mild head injuries come to the emergency room, should all of them require a CT scan immediately? This question usually test the wisdom of emergency doctors. Methods: We collected 402 cases with mild head injuries in a district hospital of Nantou County from Jan. 1st, to July 31st 2010, with age, gender, paths of arriving emergency room, time spent on transportation, Taiwan Triage and Acuity Scale, as well as decision to have CT scan arrangement, as our independent and dependent variables, respectively. Descriptive analyses and further inferent analyses were used for statistical inference. Results: Among 402emergency mild head injury cases, including 231 males, 171 females, and average age of 47 years old, there were 328 patients (80.6%) having brain CT. The positive finding rate was 17.3%. After a few hours of observation at emergency department, 96 patients (16 of them admitted to intensive care unit for closely observation) were hospitalized. There was only one patient in deteriorated condition and need for emergency craniotomy operation. Conclusions: The results showed the positive finding rate of brain CT only up to 17.3% (including hydrocephalus). However, with considering the potential malpractice and troublesome medical lawsuit in Taiwai nowady, brain CT arrangement is still the best choice for head trauma patient if they meet themedicalcriteria (i.e, Triage).

並列關鍵字

head injury ； brainCT ； Taiwai Triage and Acuity Scale