成人頭部外傷何時要做電腦斷層呢?(brain trauma and indication of CT image)

這裡當一成人的昏迷指數是介在13到15分的情況下

什麼時候可以做電腦斷層掃描。

分兩個狀況：

 
假如一成人Glasgow Coma Scale score of 15 and blunt head trauma that occurred within the previous 24 hours that caused loss of consciousness, definite amnesia, or witnessed disorientation.
病人若有以下一個以上條件就可以考慮：

• 頭痛 Headache
• 嘔吐
• 年齡大於60歲 Age > 60 year-old
• 藥物或酒精中毒 Drug or alcohol intoxication
• 持續性的失憶 Persistent anterograde amnesia (deficits in short-term memory)
• 鎖骨以上明顯外傷 Visible trauma above the clavicle
• 抽搐 Seizure

這是New Orleans Criteria for Determining if CT Is Indicated After Minor Head Injury


若一成人有minor head injury (defined as GCS score of 13 to 15 after loss of consciousness, definite amnesia, or witnessed disorientation from trauma)
病人若有以下一個以上條件就可以考慮：
高風險

• GCS score lower than 15 two hours after injury
• Suspected open or depressed skull fracture
• Any sign of basal skull fracture (e.g., hemotympanum, “raccoon eyes,” cerebrospinal fluid, otorrhea or rhinorrhea, Battle’s sign [bluish discoloration of the postauricular region])
• Two or more episodes of vomiting
• Age 65 years or older

中度風險

• Loss of consciousness for more then 5 minutes
• Amnesia before impact of 30 minutes or more
• Dangerous mechanism (i.e., pedestrian struck by motor vehicle, occupant ejected from motor vehicle, or a fall from a height of at least 3 ft or five stairs)

這是The Canadian CT Head Rule for patients with minor head injury

但若病人有在服用抗凝血劑，則還是有需要考量。
CT= computed tomography，電腦斷層掃描

參考資料

1. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343:100–5
2. ATLS, 9th edition
3. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357:1391–6