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延迟内出血的发生率和结果:基于人口的队列研究
Hyojeong Kwon1, Youn-Jung Kim2, Jae-Ho Lee3,4
1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Scientific reports
|August 22, 2024
概括
延迟内出血 (ICH) 发生在0.4%的轻微头部创伤患者中,CT扫描结果呈阴性. 这种情况显著增加了1年的死亡率,这表明需要密切观察出院后的情况.
科学领域:
- 神经科学是一个神经科学.
- 紧急医疗 紧急医疗
- 公共卫生 公共卫生
背景情况:
- 头部创伤是急诊室访问的常见原因之一.
- 在轻微的头部创伤后延迟的内出血 (ICH) 带来了诊断和管理的挑战.
- 讨论了头部创伤患者初始脑CT扫描结果阴性后出院计划的当前指导方针.
研究的目的:
- 为了确定晚期ICH在成年人的发病率,轻微的头部创伤和最初负面的大脑CT扫描.
- 调查与延迟的ICH相关的临床结果,包括1年死亡率.
- 评估在最初的急诊室访问后延迟ICH诊断的时间.
主要方法:
- 全国范围的人口队列研究利用韩国国家健康保险服务 (2013-2019) 的数据.
- 包括成年患者 (≥20岁) 提交ED轻微头部创伤和负初始脑CT.
- 使用Cox比例危险回归进行长达1年的随访,以评估延迟的ICH诊断 (14天内) 和临床结果,包括死亡率.
主要成果:
- 总共分析了626,695名成年患者;2,666名 (0.4%) 在14天内被诊断出延迟的ICH.
- 大多数延迟的ICH病例 (64.3%) 在3天内被诊断出来,84.5%在7天内被诊断出来.
- 延迟的ICH与1年全因死亡率的增加显著相关 (调整后的危险比,2.15;p < 0.001).
结论:
- 在轻微的头部创伤和负面的初始CT扫描后,延迟ICH的发生率为0.4%,大多数诊断发生在一周内.
- 延迟的ICH是1年死亡率的重要独立风险因素.
- 患者教育强调在出院后大约一周的密切观察可能是管理轻微头部创伤患者的实际策略.
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