轻度创伤性脑损伤中孤立性创伤性蛛网膜下腔出血的临床意义：一项荟萃分析。
The clinical significance of isolated traumatic subarachnoid hemorrhage in mild traumatic brain injury: A meta-analysis.
作者信息
Nassiri Farshad, Badhiwala Jetan H, Witiw Christopher D, Mansouri Alireza, Davidson Benjamin, Almenawer Saleh A, Lipsman Nir, Da Costa Leodante, Pirouzmand Farhad, Nathens Avery B
机构信息
From the Division of Neurosurgery, Department of Surgery (F.N., J.H.B., C.D.W., A.M., B.D.), University of Toronto, Toronto Ontario, Canada; Division of Neurosurgery (N.L., L.D.C., F.P.), Sunnybrook Health Sciences Center, Toronto Ontario, Canada; Division of Neurosurgery, Department of Clinical Epidemiology and Biostatistics (S.A.A), McMaster University, Hamilton, Ontario, Canada; and Division of General Surgery and Trauma (A.B.N.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
出版信息
J Trauma Acute Care Surg. 2017 Oct;83(4):725-731. doi: 10.1097/TA.0000000000001617.
BACKGROUND
The rates of clinical and radiographic progression and the need for neurosurgical intervention in patients with isolated traumatic subarachnoid hemorrhage (itSAH) after mild traumatic brain injury (Glasgow Coma Scale score, 13-15) has not been well established.The aim of this work was to review the evidence regarding patient outcomes after mild traumatic brain injury with itSAH.
METHODS
Two authors independently extracted the data according to a predefined protocol. The proportions of patients who had the outcomes of interest were pooled using random-effects model. The quality of included studies was assessed using the methodological index for nonrandomized studies scale.
RESULTS
Thirteen studies reporting on 15,327 patients met inclusion criteria, and outcomes were pooled where available. No patient required neurosurgical intervention on presentation to hospital, and the incidence of need for eventual neurosurgical intervention was 0.0017% (95% confidence interval [CI], 0-0.39%). Moreover, the pooled analyses for all patients with available data showed an incidence of 5.76% (95% CI, 1.18-12.94%) for radiographic progression, 0.75% (95% CI, 0-2.39%) for neurologic deterioration, and 0.60% (95% CI, 0.09-1.41%) for mortality. Only one patient had died due to neurological injury.
CONCLUSIONS
These patients experience very low rates of radiographic progression and neurologic deterioration and rarely require neurosurgical intervention or die due to neurological injury.
LEVEL OF EVIDENCE
Meta-analysis, level III.
背景
轻度创伤性脑损伤（格拉斯哥昏迷量表评分，13 - 15分）后孤立性创伤性蛛网膜下腔出血（itSAH）患者的临床和影像学进展率以及神经外科干预需求尚未明确。本研究旨在回顾有关轻度创伤性脑损伤合并itSAH患者预后的证据。
方法
两位作者根据预先定义的方案独立提取数据。使用随机效应模型汇总有感兴趣结局的患者比例。采用非随机研究方法学指标量表评估纳入研究的质量。
结果
13项报告15327例患者的研究符合纳入标准，如有可用数据则汇总结局。没有患者在入院时需要神经外科干预，最终需要神经外科干预的发生率为0.0017%（95%置信区间[CI]，0 - 0.39%）。此外，对所有有可用数据患者的汇总分析显示，影像学进展发生率为5.76%（95%CI，1.18 - 12.94%），神经功能恶化发生率为0.75%（95%CI，0 - 2.39%），死亡率为0.60%（95%CI，0.09 - 1.41%）。仅1例患者死于神经损伤。
结论
这些患者影像学进展和神经功能恶化发生率极低，很少需要神经外科干预或死于神经损伤。
证据级别
Meta分析，III级。
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