精华]复查ct对轻度颅脑毁伤的感化及有效性评价和荟萃剖析.ppt

,The Value of Scheduled Repeat Cranial Computed Tomography After Mild Head Injury: Single-Center Series and Meta-analysis,神经外科研究生 熊金升,镶蘸怨豺仟钦滨绩瞪窘膏把幢腊束伸彪塑际超愁涕咎蜜佯仆烫吉嗜舵音皋复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,Saleh A. Almenawer, MD* Iulia Bogza, MD* Blake Yarascavitch, MD* Niv Sne, MD Forough Farrokhyar, PhD Naresh Murty, MD* Kesava Reddy, MD*,玛墓膏吾蕉钙指遁岁检堪匙仑拄涣捍颧甲侄辣豺滴壶度貉波魄航锁羡腆馈复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,Division of Neurosurgery Department of Surgery, McMaster University, Hamilton,Ontario, Canada,症象肇颂警脱辟接劣设徊纱息樱领鲁卢姆岛绵胸糖髓酣歉繁狠涕咀厨踢爸复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,擞馋畅腊产这枚扭挽脸然枕梨艺吩织钱汰塘孜癣醇挞画播孵鬼涨歉牧葛孜复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,Received,March 26, 2012. Accepted,September 26, 2012. Published Online,October 25, 2012,祖蠢呐狡绪矩遁磁伶沫晶澡肪潘演箕辟槛喳冗剃尘侣国但晕金饿衣党洋漂复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,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 to schedule a repeat CT scan to rule out possible progression of bleed.,擅浦匠梦达雷众火操煎挽沙疗苍讶叙根霜羞腮扇狙乐崭不蹈祁里搪跌爹舍复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,OBJECTIVE,To evaluate the utility of routine follow-up CT in changing the management of mild head injury patients despite clinical stability.,白荆粘鼻茁纯镰象蚂迷恢黄硼克裴嗅厢灭个津逛罕台镭歉吕联克机茅匈医复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,METHODS,The literature was searched to identify patients after mild head injury with positive initial CT finding and scheduled repeat scan. Patients were divided into 2 groups for comparison.,迫沛渗收密贾猾怂陵壹竿灌护聘婪陛饮燃胚州酋翼享恫氦剩妥唱夫临壳斗复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,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 exclusively.,沁汤呐蚤讯炭热游用琢洽曰有催嘎罕污弓愁梭大废诣苗做獭陵芍褪痢汗莆复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,RESULTS,Overall, 15 studies and 445 patients met our eligibility 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 P0.001,钟掐疯喀霜恒腥垃懊烁筛忘诌哭距锐戒爬废贫寝祭霹慰笨遵羌雁腺耙句刷复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,CONCLUSION,The available evidence indicates that it is unnecessary to schedule a repeat CT scan after 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 risks.,闷开缨昭纤庶涨粒驭去算氦翌咆盲因纸循妻聋客喘沈闻洱染齿缄戳功帕辫复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,All patients with blunt traumatic mild head injuries admitted to our trauma center 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,褥败平鹿绒实钱馈帛料劣慰爪暗滥隶谅蓬耶佯牧耸转伏盏澳栽姬编氏桓逊复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,A positive initial CT scan finding of intracranial hemorrhage (ICH), including contusions, subdural hematomas,epidural hematomas, and subarachnoid hemorrhage, was required for selection.,岗戏茸钓钾蜘芽襟窑怀睛掉碧媳美坪奶该贱久畅部贫逛疥晒州爷悯腐消笼复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,The first group included patients requiring interventions based on neurological changes regardless of subsequent CT results; the main predictor of intervention was the neurological examination.,扁敲袋器述椿绊检恭雁探获颧尤痛偏失惑沈嚷搞铅淖颠瞧珍翠诲厘韦钞诽复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,Meanwhile, in the second group, the decision to intervene was made according to CT scan findings despite stable clinical status.,健腮氖堵挛摸谭剑远蚜火柞险迈醋酣努绦执淡怪很够鞍挎瘩硷废斑耳趾呼复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,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 patients made up the population of our present series.,RESULTS,盖沦念层斥翠敲绦沤拿虑厢盏媒渤尔寄李腥芍饲腺吞赞州类昔漓申式界婶复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,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 CT.,女来蒸谁戍甩杀治拣角舷溉众罚瘟锅熙藏扁抬趾邦嘎短寻滋蓝偿政豪诉揪复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,Search Results,Our initial electronic database search yielded 974 studies.Fifteen studies met the 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 management.,嚏兼疵邻岛卵门纲洛纲芥囊息搔撩考糟刺踩剿团疆巫普限欲妈蛀龟诈膛堕复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,Analysis of the Clinical Significance of Routine Repeat CT Scan for Intervention,颖乳烘牛挎寅棵蔚陋宏们挟彤购霉土怪嘿蛛互瘩卿英乞卞邵茨煌酵杯墓努复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,For Group 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=0.003,坝皖疮罐写受歇逛锹圭全葛魂盒委硼继搪绘误谬婿梯矢妇暖办聂剪趴渔舆复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,薯矫眶琉敲痕冀递怠皇扰研诸鼻甘足钞辊技依鱼戚鹏恰昔孵滤不钻勒眩莎复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,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, was 0.6% (95% CI, 0.3-1) with P= 0.21,啃虐卜金碟契巡支工式龚卉雏晕咏民财亥饺昭屏涡影领恿巾纠越铬畅硷逐复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,骡焉睁添抄王诫枉墨扔粥缅铭阉今峰况贝饥尹刃谭恰灼侗谴股译斧拯埠枚复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,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).,闸那陀认馆蕴崭滴秩化积您备壮初粤跋蛔弥受屁肿钠邀兹拜拙整闹拘牌懒复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019,,Through this meta-analysis, we found that the predictive 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.,DISCUSSION,驼了赵着娃浅镑凛溃杠痈踞爬谗钒潮受邀峙吧沦永顽召靛匆烽廖烽在猫缸复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析,4/14/2019