Haghbayan Hourmazd, Boutin Amélie, Laflamme Mathieu, Lauzier François, Shemilt Michèle, Moore Lynne, Zarychanski Ryan, Douville Vincent, Fergusson Dean, Turgeon Alexis F
CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec, QC, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Crit Care Med. 2017 Dec;45(12):e1280-e1288. doi: 10.1097/CCM.0000000000002731.
Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury.
MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015.
Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale.
Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation.
We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01-3.15; I = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72-3.58; I = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06-5.69; I = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias.
MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well-controlled studies are necessary to better quantify the prognostic role of early MRI in moderate and severe traumatic brain injury.
创伤性脑损伤是死亡和残疾的主要原因，然而许多预后预测指标不够精确，无法指导初始临床决策。尽管磁共振成像（MRI）在创伤性脑损伤后的早期阶段使用越来越频繁，但其预后效用仍不确定。因此，我们对评估急性MRI病变模式对创伤性脑损伤临床结局鉴别预测价值的研究进行了系统评价和荟萃分析。
从创刊至2015年11月的MEDLINE、EMBASE、BIOSIS和CENTRAL数据库。
对中度或重度创伤性脑损伤急性期进行MRI检查的成人研究。我们的主要结局是全因死亡率和格拉斯哥预后量表。
两位作者独立进行研究选择和数据提取。我们使用随机效应模型计算合并效应估计值，使用预后研究质量的修订版评估偏倚风险，并通过推荐分级、评估、制定和评价确定证据强度。
我们纳入了58项符合条件的研究，其中27项（n = 1652）为荟萃分析提供了数据。脑干病变与6个月及以上的全因死亡率（风险比，1.78；95%置信区间，1.01 - 3.15；I² = 43%）和不良格拉斯哥预后量表（风险比，2.49；95%置信区间，1.72 - 3.58；I² = 81%）相关。弥漫性轴索损伤模式与不良格拉斯哥预后量表风险增加相关（风险比，2.46；95%置信区间，1.06 - 5.69；I² = 74%）。基于病变深度的MRI评分显示，随着更多尾侧结构受累，不良神经学结局的风险增加。大多数研究存在方法学偏倚的高风险。
创伤性脑损伤后的MRI产生重要的预后信息，几种病变模式与长期生存和神经学结局显著相关。鉴于当前文献中存在较高的偏倚风险，需要开展大型严格对照研究，以更好地量化早期MRI在中度和重度创伤性脑损伤中的预后作用。
