A meta-analysis of clinical correlates that predict significant intracranial injury in adults with minor head trauma
A meta-analysis of clinical correlates that predict significant intracranial injury in adults with minor head trauma
复制标题
DOI：
10.1089/0897715041526122
复制
发表时间：
2004-07-01
影响因子：
4.2
通讯作者：
Mackway-Jones, K
中科院分区：
文献类型：
--
作者：
Dunning, J;Stratford-Smith, P;Mackway-Jones, K
先前的研究对于各种临床症状、体征和平扫影像对轻度颅脑损伤成人颅内病理的预测效果产生了相互矛盾的结果。我们试图对文献进行荟萃分析，以评估这些因素对于预测颅内出血（ICH）的重要性。使用 Medline、Embase、Experts 和 Gray 文献检索文献。对主要指南的参考清单进行了交叉检查。其中包括对因头部受伤入院的患者进行的对照或巢式病例对照研究，记录与存在或不存在 ICH 的结果变量相关的临床相关性。使用 Mantel-Haenszel 检验和汇总估计来计算常见相对风险比。经过系统回顾文献后，荟萃分析纳入了 35 篇论文，涉及 83,636 名患者。根据病史、损伤机制和检查计算 23 种临床相关因素的相对风险比。此外，对于那些在研究中表现出显着异质性的变量，还提出了调整后的相对风险。讨论了异质性的原因。这项研究确定了 23 个临床变量的相对风险，这些变量可以预测轻微头部损伤后患者是否存在 ICH。事实证明，这些风险对于临床医生评估个体患者以及评估轻微头部损伤治疗指南的价值是无价的。
Previous studies have resulted in conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in adults with minor head injury. We sought to perform a meta-analysis of the literature to assess the significance of these factors for the prediction of intracranial hemorrhage (ICH). The literature was searched using Medline, Embase, Experts, and the Grey literature. Reference lists of major guidelines were crosschecked. Included were control or nested case control studies of patients attending hospital with head injury that recorded clinical correlates relating to the outcome variable of presence or absence of ICH. The common relative risk ratio was calculated using the Mantel-Haenszel test with a pooled estimate. Thirty-five papers containing 83,636 patients were included in the meta-analysis after systematic review of the literature. Relative risk ratios were calculated for 23 clinical correlates from the history, the mechanism of injury, and the examination. In addition, adjusted relative risks were presented for those variables that showed significant heterogeneity across studies. Reasons for the heterogeneity are discussed. This study has determined the relative risks of 23 clinical variables that may predict the presence of an ICH in patients after minor head injury. These risks should prove invaluable to clinicians for the assessment of individual patients as well as the assessment of guidelines presented for the management of minor head injuries.