Department of Emergency Medicine, Stockholm South General Hospital, Stockholm, Sweden.
Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Scand J Trauma Resusc Emerg Med. 2024 Sep 17;32(1):91. doi: 10.1186/s13049-024-01262-6.
Mild traumatic brain injury (mTBI), i.e. a TBI with an admission Glasgow Coma Scale (GCS) of 13-15, is a common cause of emergency department visits. Only a small fraction of these patients will develop a traumatic intracranial hemorrhage (tICH) with an even smaller subgroup suffering from severe outcomes. Limitations in existing management guidelines lead to overuse of computed tomography (CT) for emergency department (ED) diagnosis of tICH which may result in patient harm and higher healthcare costs.
To perform a systematic review and meta-analysis to characterize known and potential novel risk factors that impact the risk of tICH in patients with mTBI to provide a foundation for improving existing ED guidelines.
The literature was searched using MEDLINE, EMBASE and Web of Science databases. Reference lists of major literature was cross-checked. The outcome variable was tICH on CT. Odds ratios (OR) were pooled for independent risk factors.
After completion of screening, 17 papers were selected for inclusion, with a pooled patient population of 26,040 where 2,054 cases of tICH were verified through CT (7.9%). Signs of a skull base fracture (OR 11.71, 95% CI 5.51-24.86), GCS < 15 (OR 4.69, 95% CI 2.76-7.98), loss of consciousness (OR 2.57, 95% CI 1.83-3.61), post-traumatic amnesia (OR 2.13, 95% CI 1.27-3.57), post-traumatic vomiting (OR 2.04, 95% CI 1.11-3.76), antiplatelet therapy (OR 1.54, 95% CI 1.10-2.15) and male sex (OR 1.28, 95% CI 1.11-1.49) were determined in the data synthesis to be statistically significant predictors of tICH.
Our meta-analysis provides additional context to predictors associated with high and low risk for tICH in mTBI. In contrast to signs of a skull base fracture and reduction in GCS, some elements used in ED guidelines such as anticoagulant use, headache and intoxication were not predictive of tICH. Even though there were multiple sources of heterogeneity across studies, these findings suggest that there is potential for improvement over existing guidelines as well as a the need for better prospective trials with consideration for common data elements in this area. PROSPERO registration number CRD42023392495.
轻度创伤性脑损伤（mTBI），即格拉斯哥昏迷量表（GCS）评分为 13-15 的 TBI，是急诊科就诊的常见原因。这些患者中只有一小部分会发展为创伤性颅内出血（tICH），其中一小部分会出现严重后果。现有管理指南的局限性导致对急诊科诊断 tICH 的 CT 过度使用，这可能会导致患者伤害和更高的医疗保健成本。
进行系统回顾和荟萃分析，以描述已知和潜在的新危险因素，这些因素会影响 mTBI 患者发生 tICH 的风险，为改进现有急诊科指南提供基础。
使用 MEDLINE、EMBASE 和 Web of Science 数据库检索文献。交叉核对主要文献的参考文献列表。结局变量为 CT 上的 tICH。对于独立危险因素，汇总了比值比（OR）。
完成筛选后，选择了 17 篇论文进行纳入，共有 26040 例患者，其中 2054 例通过 CT 证实存在 tICH（7.9%）。颅底骨折征象（OR 11.71，95%CI 5.51-24.86）、GCS<15（OR 4.69，95%CI 2.76-7.98）、意识丧失（OR 2.57，95%CI 1.83-3.61）、创伤后遗忘症（OR 2.13，95%CI 1.27-3.57）、创伤后呕吐（OR 2.04，95%CI 1.11-3.76）、抗血小板治疗（OR 1.54，95%CI 1.10-2.15）和男性（OR 1.28，95%CI 1.11-1.49）在数据综合中被确定为 tICH 的统计学显著预测因子。
我们的荟萃分析为 mTBI 中与 tICH 高风险和低风险相关的预测因子提供了额外的背景信息。与颅底骨折征象和 GCS 降低相比，一些用于急诊科指南的因素，如抗凝剂使用、头痛和中毒，与 tICH 无关。尽管研究之间存在多种来源的异质性，但这些发现表明，现有指南有改进的空间，并且需要更好的前瞻性试验，并考虑该领域的常见数据要素。PROSPERO 注册号 CRD42023392495。
