Lo Benjamin W Y, Fukuda Hitoshi, Nishimura Yusuke, Farrokhyar Forough, Thabane Lehana, Levine Mitchell A H
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
Department of Neurosurgery, Kurashiki Central Hospital, University of Kyoto, Okayama, Japan.
Surg Neurol Int. 2015 Aug 11;6:135. doi: 10.4103/2152-7806.162676. eCollection 2015.
Clinical prediction tools assist in clinical outcome prediction. They quantify the relative contributions of certain variables and condense information that identifies important indicators or predictors to a targeted condition. This systematic review synthesizes and critically appraises the methodologic quality of studies that derive both clinical predictors and clinical predictor tools used to determine outcome prognosis in patients suffering from aneurysmal subarachnoid hemorrhage (SAH).
This systematic review included prospective and retrospective cohort studies, and randomized controlled trials (RCTs) investigating prognostic factors and clinical prediction tools associated with determining the neurologic outcome in adult patients with aneurysmal SAH.
Twenty-two studies were included in this systemic review. Independent, confounding, and outcome variables were studied. Methodologic quality of individual studies was also analyzed. Included were 3 studies analyzing databases from RCTs, 8 prospective cohort studies, and 11 retrospective cohort studies. The most frequently retained significant clinical prognostic factors for long-term neurologic outcome prediction include age, neurological grade, blood clot thickness, and aneurysm size.
Systematic reviews for clinical prognostic factors and clinical prediction tools in aneurysmal SAH face a number of methodological challenges. These include within and between study patient heterogeneity, regional variations in treatment protocols, patient referral biases, and differences in treatment, and prognosis viewpoints across different cultures.
临床预测工具有助于临床结局预测。它们量化某些变量的相对贡献，并浓缩可识别针对特定疾病的重要指标或预测因素的信息。本系统评价综合并批判性评估了用于确定动脉瘤性蛛网膜下腔出血（SAH）患者结局预后的临床预测因素和临床预测工具的研究方法质量。
本系统评价纳入了前瞻性和回顾性队列研究以及随机对照试验（RCT），这些研究调查了与确定成年动脉瘤性SAH患者神经学结局相关的预后因素和临床预测工具。
本系统评价纳入了22项研究。对独立变量、混杂变量和结局变量进行了研究。还分析了各个研究的方法质量。其中包括3项分析RCT数据库的研究、8项前瞻性队列研究和11项回顾性队列研究。用于长期神经学结局预测的最常保留的显著临床预后因素包括年龄、神经学分级、血凝块厚度和动脉瘤大小。
对动脉瘤性SAH的临床预后因素和临床预测工具进行系统评价面临一些方法学挑战。这些挑战包括研究内部和研究之间患者的异质性、治疗方案的区域差异、患者转诊偏倚以及不同文化背景下治疗和预后观点的差异。
