复查CT对轻度颅脑损伤的作用及实用性评价及荟萃分析.ppt

The Value of Scheduled Repeat Cranial ComputedTomography After Mild Head Injury: Single-CenterSeries and Meta-analysis;Saleh A. Almenawer, MD* Iulia Bogza, MD* Blake Yarascavitch, MD* Niv Sne, MD? Forough Farrokhyar, PhD? Naresh Murty, MD* Kesava Reddy, MD*;Division of Neurosurgery Department of Surgery, McMaster University, Hamilton,Ontario, Canada;Received,March 26, 2012. Accepted,September 26, 2012. Published Online,October 25, 2012;BACKGROUND;OBJECTIVE;METHODS; 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;CONCLUSION ;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.; A positive initial CT scan finding of intracranial hemorrhage (ICH), including contusions, subdural hematomas,epidural hematomas, and subarachnoid hemorrhage, was required for selection.;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.; Meanwhile, in the second group, the decision to intervene was made according to CT scan findings despite stable clinical status.; 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. ; 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.;Search Results; Analysis of the Clinical Significance of Routine Repeat CT Scan for