Details

Autor(en) / Beteiligte

• Fabbri, A
• Servadei, F
• Marchesini, G
• Stein, S C
• Vandelli, A

Titel

Observational approach to subjects with mild-to-moderate head injury and initial non-neurosurgical lesions

Ist Teil von

• Journal of neurology, neurosurgery and psychiatry, 2008-10, Vol.79 (10), p.1180-1185

Ort / Verlag

London: BMJ Publishing Group Ltd

Erscheinungsjahr

2008

Quelle

BMJ Journals Archiv - DFG Nationallizenzen

Beschreibungen/Notizen

• Background:The model of care for patients with mild-to-moderate head injury and CT-detected lesions that do not require an immediate intervention is a matter of debate. This study compared the effects on outcome of a model based either on observation in a neurosurgical unit (NSU) or in a peripheral hospital (PH), making use of neurosurgical expertise via a teleradiology system.Patients and methods:The investigation reviewed the data that was prospectively collected in 865 cases with mild-to-moderate head injury and positive CT scan, not needing immediate neurosurgical evacuation. Outcome was determined at 6 months. The predictive value of location of observation on outcome was evaluated by logistic regression, after adjustment for the propensity score to the type of observation (calculated on main entry variables).Findings:700 subjects had a mild head injury, 105 had a moderate injury with GCS 13–11 and 60 with Glasgow Coma Scale (GCS) 10–9. Only 152/865 subjects (17.6%) were admitted to a NSU. During observation, neurosurgery was necessary in 117 cases (13.5%), 74/152 (48.7%) NSU-observed patients and 43/713 (6.0%; p<0.001) PH-observed cases. The outcome was unfavourable in 18% of the NSU cases versus 10% of the PH cases (p = 0.143). After correction for propensity, no significant differences were found between models of observation (NSU vs. PH; odds ratio, 0.92; 95% confidence interval, 0.49 to 1.75).Interpretation:A model of care based on observation in PH with neurosurgical consult by teleradiology system, repeat CT scanning and transfer time 30–60 min to a NSU is not detrimental for subjects with initial non-neurosurgical lesions after mild-to-moderate head injury.