A meta-analysis of variables that predict significant intracranial injury in minor head trauma
A meta-analysis of variables that predict significant intracranial injury in minor head trauma
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DOI：
10.1136/adc.2003.027722
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发表时间：
2004-07-01
影响因子：
5.2
通讯作者：
Mackway-Jones, K
中科院分区：
文献类型：
--
作者：
Dunning, J;Batchelor, J;Mackway-Jones, K
背景资料：关于各种临床症状、体征和普通影像学对儿童轻微脑损伤颅内病理学的预测作用，先前的研究提出了相互矛盾的结果。目的：对文献进行荟萃分析，以评估这些因素和儿童人群颅内出血（ICH）的意义。方法：使用Medline、Embase、Experts和灰色文献检索文献。对主要指南的参考清单进行了交叉检查。选择了对照或巢式病例对照研究，研究对象为接受过头颅X线摄影、记录常见症状和体征以及头部计算机断层扫描（CT）的头部损伤儿童。结果变量：CT存在或不存在ICH。结果：16篇论文被确定为满足纳入荟萃分析的标准，虽然不是每篇论文都包含每个相关的数据。现有证据显示汇总患者数量为1136至22420。颅骨骨折的相对危险度为6.13（95%CI 3.35至11.2），头痛1.02（95% CI 0.62 - 1.69），呕吐0.88（95% CI 0.67 - 1.15），局灶性神经病学9.43（2.89至30.8），缉获量2.82（95% CI 0.89 - 9.00），≤ 2.23（95% CI 1.20 - 4.16），和格拉斯哥昏迷评分（GCS），15/5.51结论：颅内出血与颅骨骨折、局灶性神经功能障碍、意识丧失和GCS异常之间存在统计学显著相关性。头痛和呕吐没有被发现是预测和有很大的变异性癫痫发作的预测能力。需要更多关于当前预测变量的信息，以便制定更精确的指南。目前，三个大型研究小组正在进行进一步的研究。
Background: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury.Aims: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population.Methods: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. Outcome variable: CT presence or absence of ICH.Results: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11.2), headache 1.02 (95% CI 0.62 to 1.69), vomiting 0.88 (95% CI 0.67 to 1.15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS),15 of 5.51 (95% CI 1.59 to 19.0).Conclusions: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups.