Abstract:
:Recommendations on treatment of patients with head injury were recently proposed by the National Institute for Clinical Excellence (NICE). We tested the clinical performance of NICE variables versus the proposal of the Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS). Over a 5-year period, the clinical data of 7,955 adolescent and adult patients with mild head injury were prospectively collected and patients were managed according to the NCWFNS proposal. Outcome measures were (a) any post-traumatic lesion; (b) need for neurosurgical intervention; (c) unfavorable outcome (death, permanent vegetative state, severe disability) after 6 months. The predictive value of NICE variables was tested by logistic regression analysis. Three hundred fifty-four patients (6.8%) had intracranial lesions on computed tomography (CT) scan; neurosurgical intervention was needed in 108 patients (1.3%), and an unfavorable outcome occurred in 54 patients (0.7%) at 6-month follow-up. NICE variables were less sensitive than NCWFNS (93.5%; 95% confidence interval 91.0-95.2; vs. 97.8%; 96.1-98.7; p < 0.001), but far more specific (70.0%, 69.0-71.0, vs. 45.9%, 44.8-47.0; p < 0.001) for predicting intracranial lesions. NICE variables were also more specific (66.5%, 65.5-67.5, vs. 43.5%, 42.4-44.6; p < 0.001) in the prediction of neurosurgical intervention. 99.1% of unfavorable outcomes were predicted by both protocols. The CT order rate of NICE was much lower (34.1% vs. 57.1%; p < 0.001). In sum, the variables selected by NICE recommendations, when applied to a typical broad sample of emergency medicine, are a reliable, clinically sensible tool in predicting significant outcomes in patients with mild head injury and are resource saving.
journal_name
J Neurotraumajournal_title
Journal of neurotraumaauthors
Fabbri A,Servadei F,Marchesini G,Dente M,Iervese T,Spada M,Vandelli Adoi
10.1089/neu.2005.22.1419subject
Has Abstractpub_date
2005-12-01 00:00:00pages
1419-27issue
12eissn
0897-7151issn
1557-9042journal_volume
22pub_type
杂志文章abstract::Traumatic brain injury (TBI) alters function and behavior, which can be characterized by changes in electrophysiological function in vitro. A common cognitive deficit after mild-to-moderate TBI is disruption of persistent working memory, of which the in vitro correlate is long-lasting, neuronal network synchronization...
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journal_title:Journal of neurotrauma
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pub_type: 杂志文章,随机对照试验
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更新日期:2006-06-01 00:00:00
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更新日期:2003-11-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.1993.10.201
更新日期:1993-07-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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更新日期:1998-07-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.1995.12.257
更新日期:1995-06-01 00:00:00
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journal_title:Journal of neurotrauma
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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更新日期:2014-12-01 00:00:00
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pub_type: 杂志文章,评审
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abstract::Current thinking views mild head impact (i.e., subconcussion) as an underrecognized phenomenon that has the ability to cause significant current and future detrimental neurological effects. Repeated mild impacts to the head, however, often display no observable behavioral deficits based on standard clinical tests, whi...
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pub_type: 杂志文章
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