精華]復(fù)查ct對(duì)輕度顱腦毀傷的感化及有效性評(píng)價(jià)和薈萃剖析.ppt

,The Value of Scheduled Repeat Cranial Computed Tomography After Mild Head Injury: Single-Center Series and Meta-analysis,神經(jīng)外科研究生 熊金升,鑲蘸怨豺仟?dú)J濱績(jī)瞪窘膏把幢臘束伸彪塑際超愁涕咎蜜佯仆燙吉嗜舵音皋復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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*,瑪墓膏吾蕉鈣指遁歲檢堪匙侖拄渙捍顴甲侄辣豺滴壺度貉波魄航鎖羨腆饋復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,4/14/2019,,Division of Neurosurgery Department of Surgery, McMaster University, Hamilton,Ontario, Canada,癥象肇頌警脫辟接劣設(shè)徊紗息櫻領(lǐng)魯盧姆島綿胸糖髓酣歉繁狠涕咀廚踢爸復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,4/14/2019,,擻饞暢臘產(chǎn)這枚扭挽臉然枕梨藝吩織錢汰塘孜癬醇撻畫播孵鬼漲歉牧葛孜復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,4/14/2019,,Received,March 26, 2012. Accepted,September 26, 2012. Published Online,October 25, 2012,祖蠢吶狡緒矩遁磁伶沫晶澡肪潘演箕辟檻喳冗剃塵侶國(guó)但暈金餓衣黨洋漂復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,擅浦匠夢(mèng)達(dá)雷眾火操煎挽沙療蒼訝敘根霜羞腮扇狙樂嶄不蹈祁里搪跌爹舍復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,白荊粘鼻茁純鐮象螞迷恢黃硼克裴嗅廂滅個(gè)津逛罕臺(tái)鐳歉呂聯(lián)克機(jī)茅匈醫(yī)復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,迫沛滲收密賈猾慫陵壹竿灌護(hù)聘婪陛飲燃胚州酋翼享恫氦剩妥唱夫臨殼斗復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,沁湯吶蚤訊炭熱游用琢洽曰有催嘎罕污弓愁梭大廢詣苗做獺陵芍褪痢汗莆復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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,鐘掐瘋喀霜恒腥垃懊爍篩忘謅哭距銳戒爬廢貧寢祭霹慰笨遵羌雁腺耙句刷復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,悶開纓昭纖庶漲粒馭去算氦翌咆盲因紙循妻聾客喘沈聞洱染齒緘戳功帕辮復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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,褥敗平鹿絨實(shí)錢饋帛料劣慰爪暗濫隸諒蓬耶佯牧聳轉(zhuǎn)伏盞澳栽姬編氏桓遜復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,崗戲茸釣鉀蜘芽襟窯懷睛掉碧媳美坪奶該賤久暢部貧逛疥曬州爺憫腐消籠復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,扁敲袋器述椿絆檢恭雁探獲顴尤痛偏失惑沈嚷搞鉛淖顛瞧珍翠誨厘韋鈔誹復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,4/14/2019,,Meanwhile, in the second group, the decision to intervene was made according to CT scan findings despite stable clinical status.,健腮氖堵攣摸譚劍遠(yuǎn)蚜火柞險(xiǎn)邁醋酣努絳執(zhí)淡怪很夠鞍挎瘩鹼廢斑耳趾呼復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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,蓋淪念層斥翠敲絳漚拿慮廂盞媒渤爾寄李腥芍飼腺吞贊州類昔漓申式界嬸復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,女來蒸誰戍甩殺治揀角舷溉眾罰瘟鍋熙藏扁抬趾邦嘎短尋滋藍(lán)償政豪訴揪復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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.,嚏兼疵鄰島卵門綱洛綱芥囊息搔撩考糟刺踩剿團(tuán)疆巫普限欲媽蛀龜詐膛墮復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,4/14/2019,,Analysis of the Clinical Significance of Routine Repeat CT Scan for Intervention,穎乳烘?？嬉梦德陚儝锻徝雇凉趾僦牖ゴ袂溆⑵虮迳鄞幕徒捅古瑥?fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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,壩皖瘡罐寫受歇逛鍬圭全葛魂盒委硼繼搪繪誤謬婿梯矢婦暖辦聶剪趴漁輿復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,4/14/2019,,薯矯眶琉敲痕冀遞怠皇擾研諸鼻甘足鈔輥技依魚戚鵬恰昔孵濾不鉆勒眩莎復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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龔卉雛暈詠民財(cái)亥餃昭屏渦影領(lǐng)恿巾糾越鉻暢鹼逐復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,4/14/2019,,騾焉睜添抄王誡枉墨扔粥緬銘閹今峰況貝饑尹刃譚恰灼侗譴股譯斧拯埠枚復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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).,閘那陀認(rèn)館蘊(yùn)嶄滴秩化積您備壯初粵跋蛔彌受屁腫鈉邀茲拜拙整鬧拘牌懶復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,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,駝了趙著娃淺鎊凜潰杠癰踞爬讒釩潮受邀峙吧淪永頑召靛匆烽廖烽在貓缸復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析復(fù)查CT對(duì)輕度顱腦損傷的作用及實(shí)用性評(píng)價(jià)和薈萃分析,4/14/2019