Min�r ba� travmas�nda beyin BT taramas� �ekmeden �nce ba� a�r�s� tedavisinin rol�:  �ntraven�z morfin s�lfat kafa i�i travmas�n� �ng�rebilir mi?

Ahmadi, Koorosh; Hashemian, Amirmasoud; Pishbin, Elham; Taheriniya, Ali; Jafarpour, Saba; Rahimi-movaghar, Vafa

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Min�r ba� travmas�nda beyin BT taramas� �ekmeden �nce ba� a�r�s� tedavisinin rol�: �ntraven�z morfin s�lfat kafa i�i travmas�n� �ng�rebilir mi? [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2014; 20(6): 432-436 | DOI: 10.5505/tjtes.2014.84031

Min�r ba� travmas�nda beyin BT taramas� �ekmeden �nce ba� a�r�s� tedavisinin rol�: �ntraven�z morfin s�lfat kafa i�i travmas�n� �ng�rebilir mi?

Koorosh Ahmadi¹, Amirmasoud Hashemian², Elham Pishbin², Ali Taheriniya¹, Saba Jafarpour³, Vafa Rahimi-movaghar⁴
¹Elbruz �niversitesi T�p Fak�ltesi, Acil T�p Anabilim Dal�, Karaj, �ran
²Mashad �niversitesi T�p Fak�ltesi, Acil T�p Anabilim Dal�, Mashad, �ran
³Tahran �niversitesi T�p Fak�ltesi, Sina Travma Ve Cerrahi Ara�t�rma Merkezi, �ran
⁴Tahran �niversitesi T�p Fak�ltesi, Sina Travma Ve Cerrahi Ara�t�rma Merkezi, Tahran; Tahran �niversitesi T�p Fak�ltesi, �eriat Hastanesi, N�ro�ir�rji Klini�i, Tahran; Tahran �niversitesi, Sinir Tedavisi ��in Ara�t�rma Merkezi, Tahran, �ran

AMA�: Bu �al��man�n amac�, beyin BT taramas�nda min�r kafa travmas� (MHI) bulgular� olan hastalarda ba� a�r�s�n�n morfine yan�t�n� incelemek ve BT taramas� gereken hastalar� tan�mlamak i�in yeni bir risk g�stergesini �nermektir.
GERE� VE Y�NTEM: Ba� a�r�s� ve GCS skoru 14 veya 15 ile gelen 15 ya� ve �st� toplam 1857 MHI hastas� �al��maya al�nd�. �ntraven�z morfin s�lfat yap�ld� ve hastalar daha sonra ba� a�r�s�n�n ge�mesi veya s�regelmesine g�re de�erlendirildi. Daha sonra t�m hastalar�n beyin BT taramas� �ekildi.
BULGULAR: Hastalar 15-60 ve 60 ya� �st� olmak �zere iki ya� grubuna ayr�ld�. Her iki grupta BT sonucu ile morfine yan�t aras�nda �nemli bir ili�ki mevcuttu (p<0.001). On be� ile 60 ya� aras�nda, ba� a�r�s� morfine yan�t vermi� olanlar�n hi�birinin BT taramas�nda herhangi bir anormal bulgu g�r�lmedi (duyarl�l�k= %100). Altm�� ya� �st� grupta anormal BT bulgusu ve n�ro�ir�rji giri�im endikasyonu a��s�ndan morfine yan�t�n duyarl�l�k dereceleri s�ras�yla %58.3 ve %71.4 idi.
TARTI�MA: Bu �al��ma morfinle ge�meyen ba� a�r�s�n�n kafa i�i travmas� i�in bir risk g�stergesi oldu�unu d��nd�rmektedir. BT�ye eri�imin s�n�rl� oldu�u k�rsal alanlarda, BT taramas� endike MHI hastalar�n�n se�imine ili�kin mevcut kriterlere ek olarak bu protokol kullan�labilir.

Anahtar Kelimeler: A�r� y�netimi, ba� a�r�s�; beyin yaralanmalar�; bilgisayarl� tomografi; kraniyoserebral travma; morfin.

Role of headache management in minor head injury before performing brain CT scan - can intravenous morphine sulfate predict intracranial injury?

Koorosh Ahmadi¹, Amirmasoud Hashemian², Elham Pishbin², Ali Taheriniya¹, Saba Jafarpour³, Vafa Rahimi-movaghar⁴
¹Emergency Department, Alborz University Of Medical Sciences, Karaj, Iran
²Emergency Department, Mashad University Of Medical Sciences, Mashad, Iran
³Sina Trauma And Surgery Research Center, Tehran University Of Medical Sciences, Tehran, Iran
⁴Sina Trauma And Surgery Research Center, Tehran University Of Medical Sciences, Tehran, Iran; Department Of Neurosurgery, Shariati Hospital, Tehran University Of Medical Sciences, Tehran, Iran; Research Centre For Neural Repair, University Of Tehran, Tehran, Iran

Objective: The aim of this study was to examine the association of the response of headache to morphine with the findings of brain CT scan in minor head injury (MHI), and to propose a new risk indicator to identify patients that require CT scanning.
Methods: A total of 1857 MHI patients ≥15 years old, presenting with headache and a GCS score of 14 or 15 were enrolled. Intravenous morphine sulfate was administered and patients were assessed for the relief or persistence of headache thereafter. Subsequently, a brain CT scan was obtained from all patients.
Results: Patients were divided into two age groups: 15-60 and >60 years. There was significant association between the response of headache to morphine and the result of CT in both groups (p<0.001). In patients aged 15-60, none of those whose headache had responded to morphine showed any abnormal findings in the CT scan (sensitivity=100%). In the >60 group, sensitivity was 58.3% for abnormal CT and 71.4% for neurosurgical interventions.
Conclusion: This study suggests that a headache not relieved by morphine is a risk indicator for intracranial injury. This protocol can be used in rural areas with limited access to CT as an adjunct to the existing criteria for selecting the patients with MHI for CT scanning.

Keywords: Craniocerebral Trauma, Brain Injuries, Computed Tomography, Headache, Morphine, Pain Management

Koorosh Ahmadi, Amirmasoud Hashemian, Elham Pishbin, Ali Taheriniya, Saba Jafarpour, Vafa Rahimi-movaghar. Role of headache management in minor head injury before performing brain CT scan - can intravenous morphine sulfate predict intracranial injury?. Ulus Travma Acil Cerrahi Derg. 2014; 20(6): 432-436

Sorumlu Yazar: Vafa Rahimi-movaghar, Iran
Makale Dili: �ngilizce

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