Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C, Mackway-Jones K
Emergency Medicine Research Group (EmeRGe), Manchester Royal Infirmary, UK.
Arch Dis Child. 2004 Jul;89(7):653-9. doi: 10.1136/adc.2003.027722.
Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury.
To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population.
The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected.
CT presence or absence of ICH.
Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11.2), headache 1.02 (95% CI 0.62 to 1.69), vomiting 0.88 (95% CI 0.67 to 1.15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0).
There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups.
先前的研究对于各种临床症状、体征及平片成像对轻度颅脑损伤儿童颅内病变的预测作用给出了相互矛盾的结果。
对文献进行荟萃分析，以评估这些因素及颅内出血（ICH）在儿科人群中的重要性。
使用Medline、Embase、Experts及灰色文献检索文献。对主要指南的参考文献列表进行交叉核对。选取对头部受伤儿童进行颅骨X线摄影、记录常见症状和体征以及头部计算机断层扫描（CT）的对照或巢式病例对照研究。
CT显示有无ICH。
16篇论文被确定符合纳入荟萃分析的标准，尽管并非每篇论文都包含所有相关数据。现有证据给出的汇总患者数量从1136至22420不等。颅骨骨折的相对风险比为6.13（95%可信区间3.35至11.2），头痛为1.02（95%可信区间0.62至1.69），呕吐为0.88（95%可信区间0.67至1.15），局灶性神经功能障碍为9.43（2.89至30.8），癫痫发作2.82（95%可信区间0.89至9.00），意识丧失2.23（95%可信区间1.20至4.16），格拉斯哥昏迷量表（GCS）<15为5.51（95%可信区间1.59至19.0）。
颅内出血与颅骨骨折、局灶性神经功能障碍、意识丧失及GCS异常之间存在统计学上的显著相关性。未发现头痛和呕吐具有预测性，癫痫发作的预测能力存在很大差异。需要更多关于当前预测变量的信息，以便制定更完善的指南。目前三个大型研究小组正在进行进一步研究。
