每一位创伤性颅内出血的患者都需要去ICU吗？
原作者： Danya Khoujah，李辉 翻译， 文章来源： 《中华急诊医学杂志》编辑部 发布日期：2014-09-26

 

Title: Does Everyone with a Traumatic Head Bleed Need to go to the ICU?
题目：每一位创伤性颅内出血的患者都需要去ICU吗？
Author 作者: Danya Khoujah
翻译：李 辉 校对：肖 锋

Maybe not! A new prospective study looked at 600 adult trauma patients presenting with mild traumatic intracranial hemorrhage (with a GCS 13-15), and derived a clinical instrument that predicted the need for a “critical care intervention” (and therefore needing an ICU level of care). These interventions included intubation, neurosurgical intervention and need for invasive monitoring, among other things.
未必！一项新的前瞻性的研究观察了600名成年创伤患者表现为轻微的颅内出血（格拉斯哥评分 13-15分），得到了一项用以预测是否需“重症监护干预” （因此需要ICU级别的监护治疗）的临床量表。
The derived instrument consisted of 4 variables:
得到的临床量表由4个指标组成：
1. GCS less than 15
1. 格拉斯哥评分少于15分
2.     Non-isolated head injury
2. 非独立的头外伤
3.     Age 65 years or older
3. 年龄≥65岁
4.     Evidence of swelling or shift on the initial head CT
4. 初次头颅CT提示脑水肿或移位
The presence of at least one of these variables predicted the need for critical intervention, identifying 114 of the 116 patients who actually did require it, making it 98.3% sensitive.
上述指标中至少出现一项提示需要重症监护干预，这一量表识别了116名需要重症监护的患者中的114名，敏感性达到了98.3%。
This clinical decision rule is yet to be externally validated. 
这一临床决策标准尚需其它机构的验证。
References 参考文献；
Nishijima D K, et al. Derivation of a Clinical Decision Instrument to Identify Adult Patients with Mild Traumatic Intracranial Hemorrhage at Low Risk for Requiring ICU Admission. Ann Emerg Med 63(2014); 448-456
http://www.ncbi.nlm.nih.gov/pubmed/24314900