Groot, B.N.K.Q. de (2020) Het nut van protocollair CT-cerebrum bij asymptomatisch Licht Traumatisch Hoofd-/Hersenletsel. thesis, Medicine.
Full text available on request.Abstract
Mild traumatic Head Injury (MHI), is one of the most common injuries seen in the emergency department (ED). It is defined as a (not superficial) trauma to the head (with the exception of the face) with a resulting Glasgow Coma Scale score not lower than 13, with posttraumatic loss of consciousness not exceeding 30 minutes and/or a maximum of 24 hours post traumatic amnesia. In international guidelines, it is recommended that all (adult) patients are subjected to a CT�scan of the brain, in order to rule out any intracranial abnormalities. However, there has been doubt in Dutch ED's, whether or not this rule should apply to both asymptomatic and symptomatic patients. In this retrospective cohort study, medical files from four years of patients presenting to the ED of a moderately sized Dutch hospital group, with as chief complaint "trauma capitis" were analyzed in order to gain an insight in the Dutch situation. 283 files where included, of which 115 represented symptomatic patients versus 168 asymptomatic patients. 37 (13.1%) patients with intracranial abnormalities were identified. Symptomatic patients had a significantly higher risk of intracranial abnormalities (RR 3.72 (95%CI: 1.90-7.29. p <0.001). Several specific symptoms were identified as significant risk factors for the presence of intracranial abnormalities, these were: headache, vomiting in the ED, disorientation, confusion, fits, pathological reflexes on physical examination, rigidity of extremities and the presence of a novel intention tremor (p < 0.03). Mirroring this, patients who were known to drink alcohol at the time of trauma were not significantly higher at risk of intracranial abnormalities, whereas in international studies, this was implied (p > 0.06). The significant differences that this analyzed cohort shows in comparison to the international literature on which national guidelines are presently based, warrants the (re)opening of a national discussion on the merit of performing CT-scans for all MHI patients.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Clercx, J.M. and Tijink-Callenbach, P.M.C. |
| Faculty: | Medical Sciences |
| Date Deposited: | 16 Dec 2021 14:03 |
| Last Modified: | 16 Dec 2021 14:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2881 |
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