Mild head injury - mortality and complication rate: meta-analysis of findings in a systematic literature review
Mild head injury - mortality and complication rate: meta-analysis of findings in a systematic literature review
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DOI：
10.1007/s00701-003-0115-1
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发表时间：
2003-10-01
影响因子：
2.4
通讯作者：
Britton, M
中科院分区：
文献类型：
--
作者：
Geijerstam, JLA;Britton, M
背景对于轻度脑外伤的治疗策略，是否应该是住院观察或计算机断层扫描（CT）检查和家庭护理，最近一直在讨论。指导方针和临床试验设计的必要要求是了解疾病的风险。这些都没有得到可靠的总结。本研究旨在尽可能准确地估计轻度颅脑损伤患者的死亡率、并发症发生率和CT病理发现的频率。轻度头部损伤定义为涉及意识丧失或遗忘的头部创伤，但到达医院时神经系统检查结果正常（GCS 15）。对大型数据库进行了检索，以找到相关的科学文献，并对检索到的研究进行了批判性评价。使用了符合最低质量预定标准的所有代表性患者数据集的结果。采用随机效应模型对收集的数据进行荟萃分析。检索得到24项研究，涉及24249例符合要求的患者。患者的平均死亡率较低，为0.1%（CI 0.05-0.15）。并发症，大多需要手术，发生在0.9%（CI 0.6-1.2）的情况下。在约8%（CI 6.1-9.5）的病例中，在急性期发现了以出血为主的病理CT表现。在1000名到达医院的轻度头部损伤患者中，1人死亡，9人需要手术或其他干预，约80人将在CT上显示病理结果。至少这8%的患者可能需要住院治疗。
Background. Whether the strategy for care of mild head injury should be in-hospital observation or computed tomography (CT) investigation and home care has been discussed lately. A necessary requirement for guidelines and the design of clinical trials would be knowledge about the risks of the condition. These have not been reliably summarised. The study aims to estimate as accurately as possible the mortality, the complication rates, and the frequency of pathological findings on CT in patients with mild head injury.Methods. Mild head injury was defined as head trauma involving loss of consciousness or amnesia, but where neurological findings on arrival at hospital are normal (GCS 15). Large databases were searched to find relevant scientific literature, and the retrieved studies were critically appraised. Findings were used from all representative patient data sets that met predefined standards for minimum quality. Meta-analysis using the random-effects model was performed on the data collected.Findings. The search yielded 24 studies on 24249 patients fulfilling the requirements. The mean mortality of patients was low, 0.1% (Cl 0.05-0.15). Complications, mostly requiring surgery, occurred in 0.9% (Cl 0.6-1.2) of the cases. In approximately 8% (Cl 6.1-9.5), pathological CT findings, dominated by haemorrhages, were identified in the acute phase.Conclusions. Of 1000 patients arriving at hospital with mild head injury, 1 will die, 9 will require surgery or other intervention, and about 80 will show pathological findings on CT. At least these 8% of patients will probably need in-hospital care.