复查CT对轻度颅脑损伤的作用及实用性评价和荟萃分析.pptVIP

Saleh A. Almenawer, MD* Iulia Bogza, MD* Blake Yarascavitch, MD* Niv Sne, MD? Forough Farrokhyar, PhD? Naresh Murty, MD* Kesava Reddy, MD* Received,March 26, 2012. Accepted,September 26, 2012. Published Online,October 25, 2012 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. OBJECTIVE To evaluate the utility of routine follow-up CT in changing the management of mild head injury patients despite clinical stability. 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. 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. 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 P＜0.001 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. A positive initial CT scan finding of intracranial hemorrhage (ICH), including contusions, subdural hematomas,epidural hematomas, and subarachnoid hemorrhage, was required for selection. Meanwhile, in the second group, the decision to intervene was made according to CT scan findings despite stable clinical status. RESULTS During the 5-year study period, 1121 trauma patients were