Imaging for Cerebral Edema in Diabetic Ketoacidosis: Time to Zap the CT?
Imaging for Cerebral Edema in Diabetic Ketoacidosis: Time to Zap the CT?
复制标题
糖尿病酮症酸中毒脑水肿的影像学检查：是时候放弃 CT 了？
DOI：
10.1097/pcc.0000000000001037
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Vavilala,MonicaS
中科院分区：
文献类型：
--
作者：
Vavilala,MonicaS
DKA。这项研究强调，虽然头部CT是用来诊断脑水肿的，但DKA和疑似CE患者的治疗决定不会受到头部CT结果的影响，事实上，获得头部CT可能会导致高渗治疗的显著延迟。此外，作者还提供了临床医生在头颅CT异常的情况下不治疗精神状态改变的原因表；大多数原因包括临床检查的改善。相反，超过一半(63%)头颅CT正常的患者在最初的CE治疗后接受了第二次或更多剂量的高渗治疗。综上所述，这些发现表明，上述长期趋势导致临床医生不再像过去几十年那样排序和使用头部CT扫描结果。这项研究有一些方法论问题值得讨论。多位放射科医生检查了头部CT扫描，这可能在异常发现的诊断中引入了变异性。延迟治疗的定义是根据头部CT扫描的时间，而不是精神状态改变的时间。然而，由于这项研究的回溯性，这是不可避免的，因此无论引入什么偏见，都只会低估延迟时间。这些数据是几年前的，国际儿童和青少年糖尿病协会指南在2000年、2009年和2014年(11-13)连续发布。然而，他们建议在治疗开始后进行头部CT成像的建议并没有随着时间的推移而改变。尽管研究存在局限性，但这些研究人员为我们称之为儿科DKA健康服务研究的文献提供了重要信息。虽然我们还没有完全准备好在治疗儿童DKA时完全取消头部CT扫描，但这项研究表明，临床医生即使在获得CT扫描的情况下也更加依赖神经学检查，而且还需要做进一步的工作来实施iSpad关于成像前治疗的建议。可能需要努力完善和验证DKA的神经学检查，并减少由于成像等待而造成的治疗延误，以向有脑水肿风险的DKA患者提供最佳实践和及时护理。
DKA. The study highlights that while head CT is obtained to diagnose cerebral edema, decisions about treatment of patients with DKA and suspected CE are not affected by head CT results and, in fact, obtaining a head CT may have led to a significant delay in hyperosmolar therapy. Additionally, authors provide a table of reasons why clinicians did not treat altered mental status despite an abnormal head CT; most reasons included improvement in clinical examination. Conversely, more than half of the patients (63%) with a normal head CT after initial treatment for CE received a second or more doses of hyperosmolar treatment. Together, these findings suggest that secular trends noted above have resulted in clinicians not ordering and using head CT scan results in the same way as in past decades. The study has some methodological issues that merit discussion. Multiple radiologists examined the head CT scans, which may have introduced variability in the diagnosis of abnormal findings. Delay in treatment was defined from time of head CT scan rather than time of altered mental status. However, this was unavoidable due to the retrospective nature of the study and whatever bias was introduced because of this would only have underestimated the delay time. The data are a few years old and International Society for Pediatric and Adolescent Diabetes guidelines were published serially in 2000, 2009, and 2014 (11–13). However, their recommendations that head CT imaging occur after treatment is initiated have not changed over time. Despite study limitations, these investigators have contributed important information to the literature regarding what we would call health services research in pediatric DKA. Although we are not quite ready to zap head CT scans completely in the treatment of pediatric DKA, this study suggests that clinicians are relying more heavily on the neurologic examination even when CT scans are obtained, and that further work is to be done to implement ISPAD recommendations on treatment before imaging. Efforts to refine and validate the neurologic examination for DKA and reduce treatment delays due to imaging waits may be required to provide best practice and timely care to DKA patients at risk of cerebral edema.
影响因子：
158.5
作者：
N. Glaser;P. Barnett;I. McCaslin;David L. Nelson;J. Trainor;J. Louie;F. Kaufman;K. Quayle;M. Roback;R. Malley;N. Kuppermann
通讯作者：
N. Kuppermann
糖尿病酮症酸中毒治疗期间儿童亚临床脑肿胀。
影响因子：
158.5
作者：
E. Krane;M. Rockoff;J. Wallman;J. Wolfsdorf
通讯作者：
J. Wolfsdorf
小儿糖尿病酮症酸中毒脑水肿
DOI：
--
发表时间：
1990
期刊：
The Lancet
影响因子：
--
作者：
FernandoA. Bello;J. Sotos
通讯作者：
J. Sotos