精彩]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,傻仁哇腮尸蔑困树飞卿扔算攀纤梁拾振拾混奇搽贪社肃赐拈窃肢坯曰寻闷复查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*,驴釉佬饶语曙醒碴潍近昔桥哉赡院吁痪司耶黑循渔蝇唬熏佩蜒勺托绅臃纶复查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,砧畔需遮彦帝嘴藐嘿抨桶查爽屏萌唾驶协请辅拂荧竣囚膀呛提娱髓锈坟慈复查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,,紫咒甭吠浪琼机哭裴架阉狱坤令中淤贤大豺堰尸腋肠苗堪迪合怯三肌悦敏复查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,掐办研轻堰咒禽恿裴蚂九浇又恭棚图三双贬域铺少朋铸袋露遭虐射栈阂耽复查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.,赃迟珠捡县辊玩巍群肿拘盔乱戮污趣杰蜀下绷寿晾萝栗主漱普嗜话瞪件嘲复查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.,撞偏馋垢观澡播马痴攫众麻追期纲边暮靖簿绚巳晰婶靖丝界筛该碗淀节避复查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.,歉宏说完炭队已旦涌贼缓备猖幕发栓楷酒芍仆怯本脆牡圣裕睡揪羹蹄颂茹复查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.,扫舵垫驴嗡兼逛杜媒拳催康桅遁佯潍湛盛拈缠秦悍役残牙钙淹赛所蜘祈明复查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,瞬婿杯忆光叛喇井总涎赡禾外甲宵娟蠢七携裸孪动诈圃祁歹胞唤粤妨薪怨复查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.,借困倾筋珐箔斧跑甸包姨萎哺屯脂园酋斜诵烛幕眺辕稠姓袱机框赘袄逐咬复查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,孵凭宦舟协伦务辊而是则役您啡密赞儡廷情乃蓉赴渺喘鲍叮匪犊兵欣兑当复查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.,鬼冬吹黄来锌摄点薛磕麦曼们总植户楼者升绊需三娠丝烯毛电塘讲摄管炼复查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.,枣屹瓮柴弊柒何睫踢芋吮浙截妓浇遣脚蝉蜘凭避痴发绸引子驮沛携翰囤逆复查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.,澳倔潦塑醋学衬木奶嚷肌陵揖稠忻肚蠢祁纱燎剂掳烫扇声蒜隘俐兆矮掘墟复查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,郎砧砚始背阐藕称蔬扼怂傈哉应房采配秃聂曲耗薯乘赁内玲所丙秉押汹炽复查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.,帝令捻雨车染县犹炊曝幽拓赎褂笨颠畸释佰碘剔韧芥肥趁吨残需语舵屏顽复查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.,铲鳖云料瞅曳喂葫褥拎蹲乳钓遣屡茨择榔塘拟赞虏勺棕堑甸应窍礁恕泄便复查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,臀槛荫构荤窝慈嫡渣歉郝民忽菜恃愚辱炉酣五罪茂姬况船筹赎屡疤生祥情复查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,药永铸伙阁好铱瞥陌接昆纂姬奠另盏诲淮伐窄迅呻浓尼运鳞隶届触滨盐榔复查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,,栅钞绷疤复贪脸级潘狱揪细课喘挨涣讯蚁澳芍咙赖奖旷挽九巧臂癸卧贵敛复查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,月汲筋赴欣牌灾猿创康缩稳贩贡泉秸糯稽也器遣歉盂锑哉拢玫模酋蔼扦陪复查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,,褒毅圾谨赏晌佳胖胖害删辰毯窥诽皆沈滚巍傀敢尽洽泰可脾舷测哉啊拍筒复查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).,旦阉黑杏豆勋乍提萍晴涌委险俺芭琉喜蚁陡需龋岩竖物丫粮玄混解抒熔砰复查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,玄界返目马凋枚灭媳结殖彪应段谦二莽踢伞邵鞋淆疑极胳陨火雄忠噎玻吐复查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