Berkum, N.J. van (Nicole Juliëtte) (2015) Voorspellende factoren voor gecompliceerd beloop na hoofdtrauma in de huisartsenpopulatie. thesis, Medicine.
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Abstract
Background: In primary care, the care and policy for patients with a head injury are based on guidelines of the Centraal Begeleiding Orgaan (Central Body for Guidance) from 2010. At the present time there is no guideline, adapted to the population of patients with a head injury seen by general practitioners, while it is plausible that there are differences in the severity and seriousness of head injury seen in primary and secondary care. Objective: To describe clinical aspects of patients with a head injury referred by primary care to an Emergency department and to determine the predictive factors for a complicated course Methods: In this retrospective, descriptive, observational study first all 661 patients with a head injury (superficial injury included) referred by general practitioners (during the day and during out-of-hours services) in 2011/2012 were screened and finally 282 patients were included after excluding patients with solely superficial injury. Patient characteristics (age, gender, use of anticoagulants), trauma characteristics ( cause and nature) and clinical sign and symptoms were linked with clinical interventions like CT scan, hospitalization and neurosurgery. Results: Anticoagulants were used by 18.4% of the patients: by far most in the eldest age group of 75 years and older (70.2%). A CT scan was performed in 52.8%, in the eldest group even in 89.4%. The use of AC and receiving a CT scan is strongly related (88.5%). But with binary logistic regression, we displayed that older than 75 years and use of AC independently increase the chance on receiving a CT scan. Of all CT scans, 26.8% display relevant (trauma related) abnormalities. The chance on abnormality is largest in the patient group 40 years and older. More CT scans were made in patients with a fracture: in this group more abnormalities were found. Not more abnormalities were found in patients with headache, nausea, amnesia, loss of consciousness, neurological failure, hematoma, wound. Of all referred patients 51,8% were admitted. Children below 6 years (64%) en the eldest group (78,7%) were admitted most frequently. Patients using AC were also admitted frequently (76,9%); even when corrected (binomiale logistic regression) for the high use of AC by the eldest group, the admittance for AC (odds ratio 2,38) en the eldest group (odds ratio 2,61) remained high. From patients with alarm symptoms, only the group presenting retrograde amnesia was admitted more frequently than the group without this symptom. A neurosurgical intervention was done in 4 patients (1.4%); in 2 patients within 24 hours, in 2 after 24 hours. In both groups one patient died. Conclusion: It is desirable that the CBO guidelines about head injury in primary for adults will be adapted. No difference in criteria is made in risk factors, while in this study we found a predictive value for a complicated course for the following factors: use of AC, age of 75 years or older, fracture of head and retrograde amnesia.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Nijholt, Dr.I.M. |
| Supervisor name: | Bongers, Dr.F.J.M. and Gerritsen, Drs.H. and Huisartsgeneeskunde and Isala Klinieken Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:48 |
| Last Modified: | 25 Jun 2020 10:48 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/962 |
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