Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
University of Limerick, Limerick, Ireland.
Acad Emerg Med. 2019 May;26(5):479-490. doi: 10.1111/acem.13568. Epub 2019 Apr 22.
Overuse of head computed tomography (CT) for syncope has been reported. However, there is no literature synthesis on this overuse. We undertook a systematic review to determine the use and yield of head CT and risk factors for serious intracranial conditions among syncope patients.
We searched Embase, Medline, and Cochrane databases from inception until June 2017. Studies including adult syncope patients with part or all of patients undergoing CT head were included. We excluded case reports, reviews, letters, and pediatric studies. Two independent reviewers screened the articles and collected data on CT head use, diagnostic yield (proportion with acute hemorrhage, tumors or infarct), and risk of bias. We report pooled percentages, I , and Cochran's Q-test.
Seventeen articles with 3,361 syncope patients were included. In eight ED studies (n = 1,669), 54.4% (95% confidence interval [CI] = 34.9%-73.2%) received head CT with a 3.8% (95% CI = 2.6%-5.1%) diagnostic yield and considerable heterogeneity. In six in-hospital studies (n = 1,289), 44.8% (95% CI = 26.4%-64.1%) received head CT with a 1.2% (95% CI = 0.5%-2.2%) yield and no heterogeneity. In two articles, all patients had CT (yield 2.3%) and the third enrolled patients ≥ 65 years old (yield 7.7%). Abnormal neurologic findings, age ≥ 65 years, trauma, warfarin use, and seizure/stroke history were identified as risk factors. The quality of all articles referenced was strong.
More than half of patients with syncope underwent CT head with a diagnostic yield of 1.1% to 3.8%. A future large prospective study is needed to develop a robust risk tool.
已有报道称，过度使用头部计算机断层扫描（CT）来诊断晕厥。然而，目前尚未对这种过度使用情况进行文献综合分析。我们进行了一项系统综述，以确定晕厥患者行头部 CT 的使用情况和检出率，以及发生严重颅内疾病的风险因素。
我们从建库开始至 2017 年 6 月，在 Embase、Medline 和 Cochrane 数据库中进行检索。纳入包含部分或全部患者行头部 CT 的成年晕厥患者的研究。排除病例报告、综述、信件和儿科研究。两名独立的审查员筛选文章并收集有关 CT 头部使用情况、诊断检出率（急性出血、肿瘤或梗死的比例）和偏倚风险的数据。我们报告汇总百分比、I²和 Cochran's Q 检验。
纳入了 17 项包含 3361 例晕厥患者的研究。在 8 项急诊科研究（n=1669）中，54.4%（95%置信区间 [CI] = 34.9%-73.2%）的患者行头部 CT，检出率为 3.8%（95% CI = 2.6%-5.1%），且存在较大异质性。在 6 项住院患者研究（n=1289）中，44.8%（95% CI = 26.4%-64.1%）的患者行头部 CT，检出率为 1.2%（95% CI = 0.5%-2.2%），且无异质性。在 2 篇文章中，所有患者都进行了 CT（检出率为 2.3%），第 3 篇文章纳入了≥65 岁的患者（检出率为 7.7%）。异常神经学表现、年龄≥65 岁、创伤、华法林使用和癫痫/中风病史被确定为风险因素。所有参考文献的质量均较高。
超过一半的晕厥患者行头部 CT，检出率为 1.1%-3.8%。需要开展一项大型前瞻性研究来制定可靠的风险工具。
