Clinical assessment of head injuries in motorcyclists involved in traffic accidents: A prospective, observational study

ABSTRACT Objective: to review the clinical assessment of head injuries in motorcyclists involved in traffic accidents. Method: prospective observational study, including adult motorcyclists involved in traffic accidents in a period of 12 months. Patients sustaining signs of intoxication were excluded. A modification of the Canadian Head CT Rules was used to indicate computed tomography (CT). Patients not undergoing CT were followed by phone calls for three months. Collected variables were compared between the group sustaining head injuries and the others. We used chi-square, Fisher, and Student’s t for statistical analysis, considering p<0.05 as significant. Results: we included 208 patients, 99.0% were wearing helmets. Seventeen sustained signs of intoxication and were excluded. Ninety (47.1%) underwent CT and 12 (6.3%) sustained head injuries. Head injuries were significantly associated with Glasgow Coma Scale<15 (52.3% vs. 2.8% - p<0,001) and a positive physical exam (17.1% vs. zero - p<0,05). Four (2.1%) patients with intracranial mass lesions needed surgical interventions. None helmet-wearing patients admitted with GCS=15 and normal physical examination sustained head injuries. Conclusion: Head CT is not necessary for helmet-wearing motorcyclists admitted with GCS=15 and normal physical examination.

摘要
研究目的：回顾分析交通意外中摩托车驾驶员颅脑损伤的临床评估方案。
研究方法：本研究为前瞻性观察性研究，纳入12个月内涉及交通事故的成年摩托车驾驶员作为研究对象，排除存在中毒迹象的患者。采用改良版加拿大颅脑CT检查指南（Canadian Head CT Rules）作为计算机断层扫描（CT）的应用指征。未接受CT检查的患者通过电话随访时长3个月。将颅脑损伤组与其余组别收集的变量进行对比分析，采用卡方检验、Fisher确切概率法及Student t检验开展统计学分析，以p<0.05作为差异具有统计学意义的判定标准。
研究结果：本研究共纳入208例患者，其中99.0%佩戴了头盔；另有17例存在中毒迹象的患者被排除。90例（47.1%）接受了CT检查，12例（6.3%）确诊颅脑损伤。颅脑损伤与格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分<15分（52.3% vs. 2.8%，p<0.001）及体格检查阳性结果（17.1% vs. 0%，p<0.05）显著相关。4例（2.1%）存在颅内占位性病变的患者需接受手术干预。所有入院时GCS评分为15分且体格检查正常的头盔佩戴摩托车驾驶员均未发生颅脑损伤。
研究结论：对于入院时GCS评分为15分且体格检查正常的头盔佩戴摩托车驾驶员，无需行颅脑CT检查。