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Journal of the Korean Academy of Family Medicine 1995;16(9):655-668.
Published online September 1, 1995.
Clinical analysis about outcomes in mild head injured patients.
Nak Jin Seong, Ki Heum Park, Ok Hee Seo, Ju O Lee, Dong Ig Kim
경증 두부손상 환자의 예후에 관한 임상분석
성낙진, 박기흠, 서옥희, 이주오, 김동익
건국대학교의과대학 부속병원 가정의학과 임상병리과
Abstract
Background
: Head injury has been increasing because of high social mechanization and industrialization. The outcomes of mild head injured patients who had GCS score more than 13 were good. But sometimes there were fatal or disabled cases. Therefore we had investigated clinical features of head injuries that related to outcomes.

Methods : The retrospective analysis of 830 mild head injury patients who were visited to Dongguk University, Po Hang Hospital from march 1990 to february 1991 was performed which correlate outcomes to clinical features and abnormal CR findings to clinical features. We investigated age, sex, causes of injury, arrival period after injury, arrival period after injury, loss of consciousness, nausea or vomiting, anisocoria, simple skull radiography, brain CT and outcome of mild head injury patients. We investigated clinical features that are able to predict outcomes and abnormal CT findings.

Results : The people at the age of younger than 10, the third decade and the fourth decade were frequently affected. The males were more frequently affected(71.7%) than females. The most common cause was traffic accident(41.9%). The patients who visited within 3 hours after mild head injury were 89.1%. The people with loss of conciousness were 29.6%. The nausea and vomiting were shown in 17.6%. The people with anisocoria were 0.8%. The people with akull fracture were 11.4% of whom were examined by simple skull radiography. The people with abnormal CT Findings were 19.6% of patients who were examined by brain CR. The patients who were admitted in the department of neurosurgery were 212 patients(25.5%), and 17 patients(2.0%) were taken cranial operation. 823 patients(99.2%) had good recovered 6 patients(0.7%) moderately disabled, 1 patient(0.1%) was dead. There was correlation between outcomes and loss of consciousness, nausea or vomiting, skull fracture or facial bone fracture, and abnormal CR finding. There was correlation between abnormal CT findings and skull fractures or facial bone fractures.

Conclusion : The outcomes of people who had mild head injury were almost good. But physicians must be coerfal in dealing mild head injury patients because there were sometimes the cases of death or disability.
초록
연구배경 : 사회가 고도로 기계화되고 산업화됨에 따라 두부손상은 증가되고 있다. Glasgow coma scale 13점이상인 경증 두부손상 환자의 예후는 대체적으로 좋지만 이차적으로 발생할 수 있는 장애의 가능성이 있어 예후와 관련된 임상 상을 알아보았다.

방법 : 1990년 3월부터 1991년 2월까지 1년간 동국대학교 포항병원 응급실로 내원한 Glasgow coma scale 13점 이상인 경증 두부손상으로 분류된 환자 830명을 대상으로 하였다. 대상환자들에 대한 연령별 및 성별 분포, 손상의 원인, 손상후 도착시간, 의식소실, 오심과 구토, 동공부동(anisocoria), 단순 두개골 방사선 및 뇌전산화단층활영의 방사선학적 소견, 의식상태, 예후등을 조사하였다. 예후와 뇌전산화단층촬영 이상소견을 예측할 수 있는 임상 상과의 연관성을 알아보았다.

결과 : 연령은 10세 미만과 20대, 30대에서 많았고 성별은 남자가 71.7%로 많았다. 손상의 원인은 교통사고가 41.9%로 가장 많았고 손상후 3시간이내에 내원한 경우는 89.1%를 차지하였다. 29.6%에서 의식소실이 있었고 오심 혹은 구토는 17.6%에서 있었다 동공부동은 0.8%에서 있었다. 두개골 골절 홀은 안면골 골절은 11.4%에서 있었고 뇌전산화단층촬영 이상소견은 19.6%에서 있었다. 830명중에서 신경외과로 입원한 환자는 212명(25.5%)이었고 17명(2.0%)에서 개두술을 시행하였다. 완전회복은 823명(99.2%) 경미한 장애는 6명(0.7%), 사망 1(0.1%)이었다. 의식소실, 오심 혹은 구토, 두개골 골절 혹은 안면골 골절, 외전산화단 층촬영 이상소견과 예후는 통계학적 유의성이 있었다. 두개골 골절 혹은 안면골 골절은 뇌전산화단 층촬영 양성소견과 통계학적 유의성이 있었다.

결론 : 경증 두부손상의 예후는 대체적으로 좋았지만 드물게 사망하거나 장애를 남기는 경우가 있기 때문에 일차의료에서 경증 두부손상 환자를 대했을 때 신중을 기해야 하겠다.


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