Chauny Jean-Marc, Marquis Martin, Bernard Francis, Williamson David, Albert Martin, Laroche Mathieu, Daoust Raoul
Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
J Emerg Med. 2016 Nov;51(5):519-528. doi: 10.1016/j.jemermed.2016.05.045. Epub 2016 Jul 26.
Delayed intracranial hemorrhage is a potential complication of head trauma in anticoagulated patients.
Our aim was to use a systematic review and meta-analysis to determine the risk of delayed intracranial hemorrhage 24 h after head trauma in patients who have a normal initial brain computed tomography (CT) scan but took vitamin K antagonist before injury.
EMBASE, Medline, and Cochrane Library were searched using controlled vocabulary and keywords. Retrospective and prospective observational studies were included. Outcomes included positive CT scan 24 h post-trauma, need for surgical intervention, or death. Pooled risk was estimated with logit proportion in a random effect model with 95% confidence intervals (CIs).
Seven publications were identified encompassing 1,594 patients that were rescanned after a normal first head scan. For these patients, the pooled estimate of the incidence of intracranial hemorrhage on the second CT scan 24 h later was 0.60% (95% CI 0-1.2%) and the resulting risk of neurosurgical intervention or death was 0.13% (95% CI 0.02-0.45%).
The present study is the first published meta-analysis estimating the risk of delayed intracranial hemorrhage 24 h after head trauma in patients anticoagulated with vitamin K antagonist and normal initial CT scan. In most situations, a repeat CT scan in the emergency department 24 h later is not necessary if the first CT scan is normal. Special care may be required for patients with serious mechanism of injury, patients showing signs of neurologic deterioration, and patients presenting with excessive anticoagulation or receiving antiplatelet co-medication.
迟发性颅内出血是抗凝治疗患者头部外伤的潜在并发症。
我们的目的是通过系统评价和荟萃分析，确定初始脑计算机断层扫描（CT）正常但受伤前服用维生素K拮抗剂的患者头部外伤后24小时发生迟发性颅内出血的风险。
使用控制词汇和关键词检索EMBASE、Medline和Cochrane图书馆。纳入回顾性和前瞻性观察性研究。结局包括伤后24小时CT扫描阳性、需要手术干预或死亡。采用随机效应模型中的logit比例估计合并风险，并给出95%置信区间（CI）。
共识别出7篇文献，涵盖1594例首次头部扫描正常后再次扫描的患者。对于这些患者，24小时后第二次CT扫描颅内出血发生率的合并估计值为0.60%（95%CI 0-1.2%），由此导致的神经外科干预或死亡风险为0.13%（95%CI 0.02-0.45%）。
本研究是首次发表的荟萃分析，估计了维生素K拮抗剂抗凝且初始CT扫描正常的患者头部外伤后24小时发生迟发性颅内出血的风险。在大多数情况下，如果首次CT扫描正常，24小时后在急诊科重复进行CT扫描是不必要的。对于受伤机制严重的患者、出现神经功能恶化迹象的患者以及抗凝过度或接受抗血小板联合用药的患者，可能需要特别护理。
