神经外科医师协会关于体位性斜头畸形患者诊断的系统评价与循证指南：影像学的作用
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients With Positional Plagiocephaly: The Role of Imaging.
作者信息
Mazzola Catherine, Baird Lissa C, Bauer David F, Beier Alexandra, Durham Susan, Klimo Paul, Lin Alexander Y, McClung-Smith Catherine, Mitchell Laura, Nikas Dimitrios, Tamber Mandeep S, Tyagi Rachana, Flannery Ann Marie
机构信息
*Goryeb Children's Hospital of Atlantic Health Systems, Morristown, New Jersey; ‡Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; §Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ¶Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida; ‖Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; #Semmes-Murphey Neurologic & Spine Institute; Department of Neurosurgery, University of Tennessee Health Science Center, and Le Bonheur Children's Hospital, Memphis, Tennessee; **St. Louis Cleft-Craniofacial Center, SSM Health Cardinal Glennon Children's Hospital at Saint Louis University, Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri; ‡‡Department of Neurosurgery, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina; §§Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶¶Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‖‖Advocate Children's Hospital, Oak Lawn, Illinois; ##Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ***Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; ‡‡‡Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana.
出版信息
Neurosurgery. 2016 Nov;79(5):E625-E626. doi: 10.1227/NEU.0000000000001427.
BACKGROUND
No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly.
OBJECTIVE
The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis?
METHODS
The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III).
RESULTS
A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated.
CONCLUSION
Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_2.
背景
目前尚无关于体位性斜头畸形患者影像学检查的循证指南。
目的
本系统评价及循证指南旨在回答以下问题，即体位性斜头畸形婴儿进行诊断时是否需要影像学检查？
方法
使用与作为诊断斜头畸形手段的影像学相关的医学主题词和关键词，检索美国国立医学图书馆的Medline数据库和Cochrane图书馆。对摘要进行了审查，并编制了一份证据表，总结了各项研究及证据质量（I - III级）。根据文献质量给出了推荐意见（I级、II级或III级）。
结果
共筛选出42篇全文进行综述。其中，10篇被排除；因此，最终选定32篇全文作为手稿。没有I级证据，但纳入了2篇II级和30篇III级研究。对三维颅骨地形图成像、超声、颅骨X线、计算机断层扫描和磁共振成像进行了研究。
结论
临床检查通常足以诊断斜头畸形（质量，III级；强度，III级）。在本系统评价的范围内，证据表明影像学检查很少有必要，应仅用于临床检查结果不明确的病例。许多影像学研究并非旨在探讨成像方式的诊断效用，作者实际上是在评估影像学在纵向随访中的效用，而非初始诊断效用。因此原因，部分综述研究的证据级别被下调。如有需要，三维颅骨地形图照片、颅骨X线或超声成像几乎总是足以做出明确诊断。不应使用计算机断层扫描来诊断斜头畸形，但可能有必要排除颅缝早闭。完整的指南文件可在https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_2获取。
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