优质]复查ct对轻度颅脑毁伤的感化及有效性评价和荟萃剖析课件.ppt

1、The Value of Scheduled Repeat Cranial ComputedTomography After Mild Head Injury:Single-CenterSeries and Meta-analysis神经外科研究生神经外科研究生 熊金升熊金升 Saleh A.Almenawer,MD*Iulia Bogza,MD*Blake Yarascavitch,MD*Niv Sne,MD Forough Farrokhyar,PhD Naresh Murty,MD*Kesava Reddy,MD*Division of NeurosurgeryDepartment of

2、 Surgery,McMaster University,Hamilton,Ontario,C Received,March 26,2012.Accepted,September 26,2012.Published Online,October 25,BACKGROUND After an initial computed tomography(CT)scan revealing intracranial hemorrhage resulting from traumatic brain injury,a standard of care in many trauma centers is t

3、o schedule a repeat CT scan to rule out possible progression of OBJECTIVE To evaluate the utility of routine follow-up CT in changing the management of mild head injury patients despite clinical METHODS The literature was searched to identify patients after mild head injury with positive initial CT

4、finding and scheduled repeat scan.Patients were divided into 2 groups for Group A included patients who had intervention based on neurological examination changes.Group B comprised patients requiring a change in management according to CT results RESULTS Overall,15 studies and 445 patients met our e

5、ligibility criteria,totaling 2693 patients.Intervention rates of groups A and B were 2.7%and 0.6%respectively.The statistical difference between both intervention rates was clinically significant with PCONCLUSION The available evidence indicates that it is unnecessary to schedule a repeat CT scan af

6、ter mild head injury when patients are unchanged or improving neurologically.In the absence of supporting data,we question the value of routine follow-up imaging given the associated accumulative increase in cost and All patients with blunt traumatic mild head injuries admitted to our trauma center

7、between April 2006 and March 2011 were reviewed.Only adult patients(17 years old)with mild head injury,as defined by having a Glasgow Coma Score of 13,14,or 15,were included.PATIENTS AND METHODS A positive initial CT scan finding of intracranial hemorrhage(ICH),including contusions,subdural hematoma

8、s,epidural hematomas,and subarachnoid hemorrhage,was required for The first group included patients requiring interventions based onneurological changes regardless of subsequent CT results;the main predictor of intervention was the neurological Meanwhile,in the second group,the decision to intervene

9、 was made according to CT scan findings despite stable clinical During the 5-year study period,1121 trauma patients were admitted to our center with mild head injury and ICH detected on CT.We excluded 676 patients who failed to meet the previously described eligibility criteria.The remaining 445 pat

10、ients made up the population of our present series.RESULTS After the CT scan was repeated,91 images(20.4%)showed an increase in ICH,and 354 scans(79.6%)remained unchanged or improved after the initial CTSearch Results Our initial electronic database search yielded 974 studies.Fifteen studies met the

11、 previously discussed eligibility criteria.The number of patients from the included studies totaled 2248,Overall,22.4%of these images were considered worse and clearly were not always a factor leading to the alteration of Analysis of the Clinical Significance of Routine Repeat CT Scan for I For Grou

12、p A,the calculated Q test was 41.2 and I=63.6%.The weighted proportion of a change in management based on the neurological examination was 2.7%(95%CI,1.7-3.9)with P= In group B,the Q test was 19 and I=21.2%.The weighted proportion of intervention based on CT results,despite neuro-logical stability,w

13、as 0.6%(95%CI,0.3-1)with P=We compared the intervention rate based on routine repeat CT with the intervention rate based on neurological examination changes,and the difference between the intervention rates was statistically significant(P0.001) Through this meta-analysis,we found that the predictive

14、 factor for intervention is the neurological examination and that the clinical status is the guide for the need to repeat imaging.the lack of randomized trials is one of the limitations.DISCUSSIONCONCLUSION Although the standard of care in many trauma centers is to schedule a repeat CT within 24 hou

15、rs for patients with mild head injury,regardless of the neurological status to rule out secondary changes,our data suggest that this is Furthermore,we found that the simple yet important neurological examination is the predictive factor of changing the management and guiding the need for repeat imaging after mild head Thank You!神经外科研究生神经外科研究生 熊金升熊金升