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Journal of the Korean Academy of Family Medicine 1995;16(4):228-238.
Published online April 1, 1995.
A Clinical analysis on head injuries.
Chong Hoon Lee, Mon Jong Oh, Jae Jin Choi, Kek Hwan Chung, Hak Sung Kim, Hae Ryong Choi
두부외상의 임상적 고찰
이종훈, 오문종, 최재진, 정극환, 김학성, 최해룡
고신의대 가정의학교실 부산대학병원 가정의학교실
Abstract
Background
: Currently, the head trauma is acknowledged as the prime cause to death in the getting increased traffic accidents and industrial injuries. Generally, the post-treatment physical and mental sequelae which head-trauma patients mostly suffered could be developed as the critical disabilities. In this investigation, major causes, occurances and associated injuries of head trauma that were treated in our emergency room by our medical residents was evaluated in order to develop the initial evaluations that could estimate the prognosis of patients accurately.

Methods : The 209 case which admitted in our neurosurgery through emergency room from 1, January 1993 to, 31, January 1994 was evaluated as the analyzed group. All of reviewed case was involved head trauma and experienced the computerized tomography diagnosis of brain.

Results : The major cause of admitted head trauma case was turned to be traffic accidents as 78.3%. Glasgrow Coma Scale score on arrival was 58.8% in 13-15, 29.7% in 9-12, 11.5%, in 3-8. The skull fracture was estimated 28.7%, and abnormal finding in computerized tomography was 37.7% The most common lesion in computerized tomography was found as the hemorrhagic contusion, subdural hematoma, and then epidural hematoma. And, degree of abnormal finding in computerized tomography accrding to Glasgrow Coma Scale was characterized as 100% in 3-5, 99.2% in 6-8, 80.2% in 9-12, 20.6% in 13-15. The 10.5% of 209 case underthrough the operations, and the mortality rate was 2.2%. The severe associated injuries were sequentialy developed as facial fractrue, extremity fracture and chest contusion.

Conclusion : The primary cause of head turama was observed as traffic accidents. Regarding to the degree of Glasgow Coma Scale, the low score generally inclined to the skull fracture, abnormal finding in computerized tomogaphy and sequale. Therefore, the on-arrival Glasgow Coma scale could be the critical estimate in prognosis of forward outcome and sequelae.
초록
연구배경 : 격증하는 자동차 사고 및 대량사고로 인한 다발성 손상이 많아지고 있는 이시점에서 두부외상이 사망의 주요 원인으로 자리를 잡고 있다. 이에 저자들은 의식장애를 동반한 두부손상 환자의 일반적인 특성을 분석, 고찰함으로써 환자 상태의 예후 및 사망률에 영향을 주는 요소들을 파악하여 합병증 및 사망률의 감소에 도움이 되고자 본 연구를 시행하였다.

방법 : 1993년 1월부터 1994년 1월 말까지 13개월간 혜민병원 응급실로 내원하여서 뇌전산화 단층활영을 시행하고 신경외과에 입원 가료한 209명의 환자를 대상으로 의무기록을 소급하여 조사하였다.

결과 : 두부외상의 원인중 교통사고가 71.7%로 대다수를 차지하였고 내원 당시의 Glasgow Coma Scale에 의해 경도(13-15) 두부외상이 58.8%, 중증도(9-12) 29.7%, 중증(3-8) 11.5%의 순이었다. 두개골 골절률은 28.7%이었으며 뇌전산화 단층촬영의 병소 발견율은 37.7%였으며 가장 흔한 병소는 출혈성 좌상이었고 그 다음이 경막하혈종, 경막외혈종 순이었다. 심한 부외상으로서 안면부 골절 및 좌상(치아골절 포함), 사지골절, 흉부손상 순이었다.

결론 : 두부외상의 대부분은 교통사고였으며 Glasgow Goma Scale 점수는 적을 경우 두개골 골절 및 뇌전산화 단층촬영상 이상소견이 많았으며, 중한 신경학적인 장애와 치사율이 높아짐을 알 수 있었다. 그러므로 내원 당시의 Glasgow Coma Scale이 향후 예후판정에 중요한 기준의 하나가 될 수 있다고 사료된다.


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