PDF(Pubmed)
Abstract：
UNASSIGNED: Early discharge from the emergency department (ED) or a 6-hour observation in the ED are two methods for management of patients with mild traumatic brain injury (mTBI) with normal brain computed tomography (CT) scan. This study aimed to compare the outcomes of the two management options.
UNASSIGNED: This study is a single-center, open-label, pilot randomized case control study conducted in the ED of Ramathibodi Hospital from June 2022 to September 2023. Eligible participants included all individuals with mTBI who had negative findings on Brain CT scans. They were randomly assigned to either the early ED discharge or 6-hour ED observation group and compared regarding the outcomes (rate of 48-hour ED revisits; occurrence of post-concussion syndrome (PCS) 1 day, 1 month, and 3 months after the initial injury; and 3-month mortality).
UNASSIGNED: 122 patients with the mean age of 74.62 ± 14.96 (range: 25-99) years were consecutively enrolled (57.37% female). No significant differences were observed between the early discharge and observation groups regarding the severity of TBI (p=0.853), age (p=0.334), gender (p=0.588), triage level (p=0.456), Glasgow Coma Scale (GCS) score (p=0.806), comorbidities (p=0.768), medication usage (p=0.548), mechanism of injury (p=0.920), indication for brain CT scan (p=0.593), time from TBI onset to ED arrival (p=0.886), and time from ED triage to brain CT scan (p=0.333). Within 48 hours after randomization, the incidence of revisits was similar between the two groups (1.57% vs. 3.23%; p = 1.000). There were no statistically significant differences in the incidence of PCS between the early discharge and observation groups at 1 day (33.90% vs. 35.48%, p = 0.503), at 1 month (12.07% vs. 13.11%, p = 0.542), and at 3 months (1.92% vs. 5.56%, p = 0.323) after randomization. After a three-month follow-up period, four patients in the early discharge group, had expired (none of the deaths were associated with TBI).
UNASSIGNED: It seems that, in mTBI patients with normal initial brain CT scan and the absence of other injuries or neurological abnormalities, early discharge from the ED without requiring observation could be considered safe.
UNASSIGNED: This study is a single-center, open-label, pilot randomized case control study conducted in the ED of Ramathibodi Hospital from June 2022 to September 2023. Eligible participants included all individuals with mTBI who had negative findings on Brain CT scans. They were randomly assigned to either the early ED discharge or 6-hour ED observation group and compared regarding the outcomes (rate of 48-hour ED revisits; occurrence of post-concussion syndrome (PCS) 1 day, 1 month, and 3 months after the initial injury; and 3-month mortality).
UNASSIGNED: 122 patients with the mean age of 74.62 ± 14.96 (range: 25-99) years were consecutively enrolled (57.37% female). No significant differences were observed between the early discharge and observation groups regarding the severity of TBI (p=0.853), age (p=0.334), gender (p=0.588), triage level (p=0.456), Glasgow Coma Scale (GCS) score (p=0.806), comorbidities (p=0.768), medication usage (p=0.548), mechanism of injury (p=0.920), indication for brain CT scan (p=0.593), time from TBI onset to ED arrival (p=0.886), and time from ED triage to brain CT scan (p=0.333). Within 48 hours after randomization, the incidence of revisits was similar between the two groups (1.57% vs. 3.23%; p = 1.000). There were no statistically significant differences in the incidence of PCS between the early discharge and observation groups at 1 day (33.90% vs. 35.48%, p = 0.503), at 1 month (12.07% vs. 13.11%, p = 0.542), and at 3 months (1.92% vs. 5.56%, p = 0.323) after randomization. After a three-month follow-up period, four patients in the early discharge group, had expired (none of the deaths were associated with TBI).
UNASSIGNED: It seems that, in mTBI patients with normal initial brain CT scan and the absence of other injuries or neurological abnormalities, early discharge from the ED without requiring observation could be considered safe.
摘要：
■从急诊科（ED）早期出院或在ED中进行6小时观察是两种方法，用于处理具有正常脑计算机断层扫描（CT）扫描的轻度创伤性脑损伤（mTBI）患者。本研究旨在比较两种管理方案的结果。
■这项研究是一个单中心，开放标签，2022年6月至2023年9月在Ramathibodi医院ED进行的试点随机病例对照研究。符合条件的参与者包括所有患有mTBI的人，他们在脑CT扫描中发现阴性。他们被随机分配到早期ED出院或6小时ED观察组，并比较结果（48小时ED再就诊率；脑震荡后综合征（PCS）1天的发生率，1个月,和初次受伤后3个月；和3个月死亡率）。
■122例患者，平均年龄为74.62±14.96（范围：25-99）岁（57.37%为女性）。在TBI的严重程度方面，早期出院组和观察组之间没有观察到显着差异（p=0.853），年龄（p=0.334），性别（p=0.588），分类水平（p=0.456），格拉斯哥昏迷量表（GCS）评分（p=0.806），合并症（p=0.768），药物使用情况（p=0.548），损伤机制(p=0.920)，脑CT扫描的指征（p=0.593），从TBI发作到ED到达的时间(p=0.886)，从ED分诊到脑部CT扫描的时间（p=0.333）。随机化后48小时内,两组之间的复诊发生率相似(1.57%vs.3.23%；p=1.000）。第1天早期出院与观察组的PCS发生率差异无统计学意义（33.90%vs.35.48%,p=0.503),在1个月时（12.07%与13.11%，p=0.542),在3个月时(1.92%vs.5.56%,随机分组后p=0.323)。经过三个月的随访，早期出院组的四名患者，已经过期（没有死亡与TBI相关）。
■看来,在初始脑CT扫描正常且没有其他损伤或神经系统异常的mTBI患者中，在不需要观察的情况下从急诊早期出院被认为是安全的.
■这项研究是一个单中心，开放标签，2022年6月至2023年9月在Ramathibodi医院ED进行的试点随机病例对照研究。符合条件的参与者包括所有患有mTBI的人，他们在脑CT扫描中发现阴性。他们被随机分配到早期ED出院或6小时ED观察组，并比较结果（48小时ED再就诊率；脑震荡后综合征（PCS）1天的发生率，1个月,和初次受伤后3个月；和3个月死亡率）。
■122例患者，平均年龄为74.62±14.96（范围：25-99）岁（57.37%为女性）。在TBI的严重程度方面，早期出院组和观察组之间没有观察到显着差异（p=0.853），年龄（p=0.334），性别（p=0.588），分类水平（p=0.456），格拉斯哥昏迷量表（GCS）评分（p=0.806），合并症（p=0.768），药物使用情况（p=0.548），损伤机制(p=0.920)，脑CT扫描的指征（p=0.593），从TBI发作到ED到达的时间(p=0.886)，从ED分诊到脑部CT扫描的时间（p=0.333）。随机化后48小时内,两组之间的复诊发生率相似(1.57%vs.3.23%；p=1.000）。第1天早期出院与观察组的PCS发生率差异无统计学意义（33.90%vs.35.48%,p=0.503),在1个月时（12.07%与13.11%，p=0.542),在3个月时(1.92%vs.5.56%,随机分组后p=0.323)。经过三个月的随访，早期出院组的四名患者，已经过期（没有死亡与TBI相关）。
■看来,在初始脑CT扫描正常且没有其他损伤或神经系统异常的mTBI患者中，在不需要观察的情况下从急诊早期出院被认为是安全的.
