摘要
背景:NICE关于处理儿童头颅损伤的指南出版于2003年6月。他们的建议与先前皇家医院外科医生联盟(RCS)出版的指南明显不同。提倡用计算机断层摄影术(CT)代替头颅X线检查和自我陈述。在英国,这些指南对于提供医疗服务的影响还不确切。方法:在英格兰西北部三所医院收集有不同程度头颅损伤儿童的所有临床资料,确定头颅X线检查、CT扫描以及自我陈述的比例。如果按照RCS或NICE的指南,头颅X线检查、CT扫描以及自我陈述的比例是可以确定的。结果:对三所医院在2000年2月至2002年8月间收住的10965 例患者的资料进行研究发现:进行头颅X线检查的患者为25%,接受CT检查的患者为0.9%,3.7%的患者为仅做自我陈述。严格按照RCS指南其结果分别为,进行X线检查者占50%,CT扫描者占1.6%,自我陈述者占7.1%,按照NICE指南其结果分别为0.3%,8.7%, 1.4%。但是如果应用呕吐3次或更多次的标准代替超过1次即进行CT检查,那么CT检查率将下降6.3%。结论:按照新的NICE指南,不会因头颅损伤患者就诊造成工作量增加。
Background: NICE guidelines for the management of head injury were published in June 2003. Their recommendations differ markedly from previous guidelines published by the Royal College of Surgeons (RCS) . In place of skull radiography and admission, computed tomography (CT) is advocated. The impact of these guidelines on service provision in the UK is unknown. Methods: Data on all clinical correlates of children presenting with any severity of head injury was collected in three hospitals in the northwest of England. The current skull radiograph (SXR), CT scan, and admission rates were determined. The rates of SXR, CT scan, and admission that should have occurred when following either the RCS or NICE guidelines were then determined. Results: Data from 10 965 patients who attended three hospitals between February 2000 and August 2002 was studied. Twenty five per cent of patients received a SXR, 0. 9% a CT scan, and 3. 7% were admitted. Strict adherence to the RCS guidelines would have resulted in a 50% SXR rate, a 1.6% CT scan rate, and a 7. 1% admission rate. Adherence to NICE guidelines would result in a 0. 3% SXR rate, an 8. 7% CT scan rate, and a 1. 4% admission rate, although the CT rate would drop to 6. 3% if vomiting three or more times in the under 12s was used instead of more than one vomit. Conclusions: The new NICE guidelines do not increase the workload caused by patients attending with head injury but they move their management from the observation ward to the radiology department.
