Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: an evidence and consensus-based update.
Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: an evidence and consensus-based update.
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DOI：
10.1186/1741-7015-11-50
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发表时间：
2013-02-25
期刊：
影响因子：
9.3
通讯作者：
Scandinavian Neurotrauma Committee (SNC)
中科院分区：
文献类型：
--
作者：
Undén J;Ingebrigtsen T;Romner B;Scandinavian Neurotrauma Committee (SNC)
轻度、中度和轻度头部损伤的处理仍然存在争议。2000年，斯堪的纳维亚神经创伤委员会（SNC）提出了这些损伤的初步处理循证指南。从那以后，出现了相当多的新证据。根据研究和评估指南评估（AGREE） II框架和建议评估、发展和评估分级（GRADE）系统的一般方法。根据系统评价和荟萃分析（PRISMA）方法的首选报告项目，基于与患者重要结果相关的临床问题，包括诊断准确性研究质量评估（QUADAS）和循证医学中心（CEBM）质量评级，进行系统的循证评价。根据结果，起草了GRADE建议、指南和出院说明。采用改进的德尔菲法达成共识，并咨询了相关的临床利益相关者。我们提出了最新的SNC指南，用于成人轻度、轻度和中度头部损伤的初始管理，包括计算机断层扫描（CT）扫描选择、入院和出院的标准，以及对患者监测常规和出院建议的建议。该指南主要用于检测神经外科干预，创伤性CT表现为次要目标。对于缺乏良好证据的因素，如医院内监测，常规在很大程度上基于共识。我们建议在广泛临床应用前对指南进行外部验证。
The management of minimal, mild and moderate head injuries is still controversial. In 2000, the Scandinavian Neurotrauma Committee (SNC) presented evidence-based guidelines for initial management of these injuries. Since then, considerable new evidence has emerged. General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Systematic evidence-based review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, based upon relevant clinical questions with respect to patient-important outcomes, including Quality Assessment of Diagnostic Accuracy Studies (QUADAS) and Centre of Evidence Based Medicine (CEBM) quality ratings. Based upon the results, GRADE recommendations, guidelines and discharge instructions were drafted. A modified Delphi approach was used for consensus and relevant clinical stakeholders were consulted. We present the updated SNC guidelines for initial management of minimal, mild and moderate head injury in adults including criteria for computed tomography (CT) scan selection, admission and discharge with suggestions for monitoring routines and discharge advice for patients. The guidelines are designed to primarily detect neurosurgical intervention with traumatic CT findings as a secondary goal. For elements lacking good evidence, such as in-hospital monitoring, routines were largely based on consensus. We suggest external validation of the guidelines before widespread clinical use is recommended.
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影响因子：
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作者：
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