1 Center for Evidence Based Medicine and Health Outcomes Research, University of South Florida , Tampa, Florida.
J Neurotrauma. 2014 Jan 1;31(1):78-98. doi: 10.1089/neu.2013.2873. Epub 2013 Nov 7.
Diagnosis and management of traumatic brain injury (TBI) is crucial to improve patient outcomes. While initial head computed tomography (CT) scan is the optimum tool for quick and accurate detection of intracranial hemorrhage, the guidelines on use of repeat CT differ among institutions. Three systematic reviews have been conducted on a similar topic; none have performed a comprehensive meta-analysis of all studies. Search of Medline, the Cochrane Library database, and Clinicaltrials.gov , and a hand search of conference abstracts and references for all completed studies reporting data on change in management following repeat CT was conducted. Two authors reviewed all studies and extracted data using a standardized form. A proportional meta-analysis was conducted using the random-effects model for outcomes related to any change in management following repeat CT. Any change in management included intracranial intervention, change in intracranial pressure monitoring, and/or administration of drug therapy. Search results yielded 6982 references. In all, 41 studies enrolling 10,501 patients were included. Change in management following repeat CT was reported in 13 prospective and 28 retrospective studies and yielded a pooled proportion of 11.4% (95% confidence interval [CI] 5.9-18.4) and 9.6% (95% CI 6.5-13.2), respectively. In a subgroup analysis of mild TBI patients (Glasgow Coma Scale score 13 to 15), five prospective and nine retrospective studies reported on change in management following repeat CT with the pooled proportion across prospective studies at 2.3% (95% CI 0.3-6.3) and across retrospective studies at 3.9% (95% CI 2.3-5.7), respectively. The evidence suggests that repeat CT in patients with TBI results in a change in management for only a minority of patients. Better designed studies are needed to address the issue of the value of repeat CT in the management of TBI.
创伤性脑损伤（TBI）的诊断和治疗对于改善患者预后至关重要。虽然初始头部计算机断层扫描（CT）是快速准确检测颅内出血的最佳工具，但不同机构在重复 CT 使用指南上存在差异。已经针对类似主题进行了三项系统评价；但没有一项对所有研究进行全面的荟萃分析。检索了 Medline、Cochrane 图书馆数据库和 Clinicaltrials.gov，以及所有报告重复 CT 后管理变化数据的已完成研究的会议摘要和参考文献的手工检索。两位作者使用标准化表格审查了所有研究并提取了数据。使用随机效应模型对与重复 CT 后任何管理变化相关的结果进行了比例荟萃分析。任何管理变化包括颅内干预、颅内压监测的变化和/或药物治疗的应用。检索结果产生了 6982 条参考文献。共有 41 项研究纳入了 10501 名患者。在 13 项前瞻性研究和 28 项回顾性研究中报告了重复 CT 后的管理变化，总合并比例分别为 11.4%（95%置信区间 [CI] 5.9-18.4）和 9.6%（95% CI 6.5-13.2）。在轻度 TBI 患者（格拉斯哥昏迷量表评分为 13-15）的亚组分析中，五项前瞻性研究和九项回顾性研究报告了重复 CT 后管理变化，前瞻性研究的合并比例为 2.3%（95% CI 0.3-6.3），回顾性研究的合并比例为 3.9%（95% CI 2.3-5.7）。证据表明，TBI 患者重复 CT 仅导致少数患者的治疗方法发生变化。需要更好设计的研究来解决重复 CT 在 TBI 管理中的价值问题。
