创伤性蛛网膜下腔出血:范围综述。
Traumatic Subarachnoid Hemorrhage: A Scoping Review.
机构信息
NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom.
出版信息
J Neurotrauma. 2022 Jan;39(1-2):35-48. doi: 10.1089/neu.2021.0007. Epub 2021 Apr 22.
Sixty-nine million people have a traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. A limited number of studies, however, evaluate recent trends in the diagnosis and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of TSAH. This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews. The review included adults with SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (mTBI), = 13), and severe TBI ( = 3); clinical management and diagnosis ( = 9); imaging ( = 3); and aneurysmal TSAH ( = 1). Of the 30 studies, two came from a low- and middle-income country (LMIC), excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be treated conservatively when considering intensive care unit admission. The Helsinki and Stockholm computed tomography scoring systems, in addition to the American Injury Scale, creatinine level, age decision tree, may be valuable tools to use when predicting outcome and death.
每年有 6900 万人患有创伤性脑损伤 (TBI),TBI 是蛛网膜下腔出血 (SAH) 的最常见原因。创伤性蛛网膜下腔出血 (TSAH) 已被描述为导致进行性神经恶化和增加发病率和死亡率的不良预后因素。然而,只有少数研究评估了创伤背景下 SAH 的诊断和治疗的最新趋势。本范围综述的目的是了解有关 TSAH 的诊断标准和管理的证据的程度和类型。本范围综述按照乔安娜布里格斯研究所 (Joanna Briggs Institute) 的范围综述方法进行。该综述纳入了因创伤而导致 SAH 的成年人,其中孤立性 TSAH (iTSAH) 是指在没有任何其他创伤性颅内放射学病理学的情况下存在 SAH,而 TSAH 是指在存在或可能存在其他创伤性颅内放射学病理学的情况下存在 SAH。从每项研究中提取的数据包括研究目的、国家、方法、人口特征、结果测量、发现总结和未来指导。有 30 项研究符合纳入标准。研究按主题分为五类:轻度 TBI (mTBI) 相关 TSAH ( = 13),严重 TBI ( = 3);临床管理和诊断 ( = 9);影像学 ( = 3);和动脉瘤性 TSAH ( = 1)。在 30 项研究中,有两项来自低收入和中等收入国家 (LMIC),不包括中国,这是一个高收入国家。患有 mTBI 相关 TSAH 的患者临床恶化和手术干预的风险非常低,在考虑入住重症监护病房时应保守治疗。赫尔辛基和斯德哥尔摩 CT 评分系统,以及美国损伤量表、肌酐水平、年龄决策树,可能是预测结局和死亡的有用工具。