전원된 외상성 뇌 손상환자에서 중증도에 따른 일상적인 반복CT의 유용성 (The Utility of Routine Serial Brain Computed Tomography for Referred Traumatic Brain Injury Patients According to the Severity of Traumatic Brain Injury)

서지정보

· 발행기관 : 대한외상학회
· 수록지 정보 : 대한외상학회지 / 22권 / 2호 / 134 ~ 141페이지
· 저자명 : 황정인, 조진성, 이승철, 이정훈

초록

Purpose: Patients with traumatic brain injury (TBI) were referred from other hospitals for further management.
In addition, patients routinely underwent computed tomography examinations of the head (HCT) in the
referral hospitals. The purpose of this study was to evaluate retrospectively the utility of routine HCT scans
according to the severity of TBI.
Methods: Patients with TBI referred to our hospital between December 2005 and July 2008 were included in
this study. We investigated HCT findings, indications for repeat HCT examinations (routine versus a neurological
change), and neurosurgical interventions. The head injury severity was divided into three categories
according to the Glasgow Coma Scale (GCS) score, including mild, moderate, and severe TBI. The use of neurosurgical
interventions between patients who underwent routine HCT scans and patients who underwent HCT
scans for a neurological change were compared according to the severity of TBI.
Results: A total of 81 patients met the entry criteria for this study. Among these patients, 67%(n=54) of the
patients underwent HCT scans on a routine basis, whereas 33%(n=27) of the patients underwent HCT scans for
a neurological change. A total of 21 patients showed signs of a worsening condition on the HCT scans.
Neurosurgical intervention was required for 23(28.4%) patients. For patients who underwent routine HCT
examinations, no patient with mild TBI underwent a neurosurgical intervention. However, one patient with
moderate TBI and three(13%) patients with severe TBI underwent neurosurgical interventions. The kappa
index, the level of agreement for HCT indications of intervention and referral reasons for intervention, was
0.65 for high hierarchy hospitals and 0.06 for low hierarchy hospitals.
Conclusion: Routine serial HCT examinations in the referred hospitals would be useful for patients with
severe head injury and for patients from low hierarchy hospitals where no emergency physicians or neurosurgeons
are available.

영어초록

Purpose: Patients with traumatic brain injury (TBI) were referred from other hospitals for further management.
In addition, patients routinely underwent computed tomography examinations of the head (HCT) in the
referral hospitals. The purpose of this study was to evaluate retrospectively the utility of routine HCT scans
according to the severity of TBI.
Methods: Patients with TBI referred to our hospital between December 2005 and July 2008 were included in
this study. We investigated HCT findings, indications for repeat HCT examinations (routine versus a neurological
change), and neurosurgical interventions. The head injury severity was divided into three categories
according to the Glasgow Coma Scale (GCS) score, including mild, moderate, and severe TBI. The use of neurosurgical
interventions between patients who underwent routine HCT scans and patients who underwent HCT
scans for a neurological change were compared according to the severity of TBI.
Results: A total of 81 patients met the entry criteria for this study. Among these patients, 67%(n=54) of the
patients underwent HCT scans on a routine basis, whereas 33%(n=27) of the patients underwent HCT scans for
a neurological change. A total of 21 patients showed signs of a worsening condition on the HCT scans.
Neurosurgical intervention was required for 23(28.4%) patients. For patients who underwent routine HCT
examinations, no patient with mild TBI underwent a neurosurgical intervention. However, one patient with
moderate TBI and three(13%) patients with severe TBI underwent neurosurgical interventions. The kappa
index, the level of agreement for HCT indications of intervention and referral reasons for intervention, was
0.65 for high hierarchy hospitals and 0.06 for low hierarchy hospitals.
Conclusion: Routine serial HCT examinations in the referred hospitals would be useful for patients with
severe head injury and for patients from low hierarchy hospitals where no emergency physicians or neurosurgeons
are available.

참고자료

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