非对比CT在急性创伤性脑损伤中的整体诊断准确性和预后价值:一项系统回顾和荟萃分析。

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Sabzar Ahmad Bhat, Mamta Panda, Dolly Anil Sharma, Lalit Kumar Gupta
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引用次数: 0

摘要

背景:外伤性脑损伤(TBI)是一个全球性的健康挑战,具有高发病率和死亡率。由于其可及性和速度,非对比计算机断层扫描(NCCT)仍然是一线成像方式,但其在不同人群中的诊断和预后效用仍未得到充分探索。目的:系统评估和量化NCCT在全球急性TBI患者中的诊断准确性和预后价值。证据获取:遵循PRISMA 2020指南,在PubMed, Embase, Cochrane Library和Scopus中进行了系统的文献检索,直至2025年4月。包括评估NCCT在急性TBI中的诊断或预后表现的研究。采用QUADAS-2进行质量评价。采用随机效应模型进行meta分析。证据综合:在筛选的2132篇文章中,41项研究符合纳入标准,涵盖76,000多名患者。NCCT检测颅内出血的敏感性和特异性分别为0.92 (95% CI: 0.89-0.95)和0.87 (95% CI: 0.82-0.91)。预后方面,中线偏移0.5 mm和基底池受压等特征与住院死亡率显著相关(OR: 3.6, 95% CI: 2.4-5.1)。年龄、GCS和扫描时间的亚组分析证实了诊断的一致性。结论:NCCT在检测颅内出血方面具有较高的诊断准确性,并为急性脑外伤的预后提供了重要的见解。它仍然是一种基础成像工具,在时间敏感的紧急情况下尤其有价值。临床影响:NCCT应优先用于创伤性脑损伤的早期诊断和风险分层,特别是在缺乏先进神经影像学的资源受限环境中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Global diagnostic accuracy and prognostic value of non-contrast CT in acute traumatic brain injury: a systematic review and meta-analysis.

Background: Traumatic brain injury (TBI) is a global health challenge associated with high morbidity and mortality. Non-contrast computed tomography (NCCT) remains the first-line imaging modality due to its accessibility and speed, yet its diagnostic and prognostic utility across diverse populations remains underexplored.

Purpose: To systematically evaluate and quantify the diagnostic accuracy and prognostic value of NCCT in acute TBI patients worldwide.

Evidence acquisition: Following PRISMA 2020 guidelines, a systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Scopus up to April 2025. Studies assessing the diagnostic or prognostic performance of NCCT in acute TBI were included. QUADAS-2 was used for quality assessment. Meta-analyses were performed using random-effects models.

Evidence synthesis: Out of 2,132 articles screened, 41 studies met inclusion criteria, encompassing over 76,000 patients. The pooled sensitivity and specificity for NCCT detecting intracranial hemorrhage were 0.92 (95% CI: 0.89-0.95) and 0.87 (95% CI: 0.82-0.91), respectively. Prognostically, features like midline shift > 5 mm and compressed basal cisterns showed a significant association with in-hospital mortality (OR: 3.6, 95% CI: 2.4-5.1). Subgroup analyses by age, GCS, and scan timing confirmed robust diagnostic consistency.

Conclusion: NCCT demonstrates high diagnostic accuracy in detecting intracranial hemorrhage and offers substantial prognostic insights in acute TBI. It remains a cornerstone imaging tool, particularly valuable in time-sensitive emergency settings.

Clinical impact: NCCT should be prioritized in emergency protocols for early diagnosis and risk stratification in TBI, particularly in resource-constrained environments lacking advanced neuroimaging.

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来源期刊
Emergency Radiology
Emergency Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
4.60
自引率
4.50%
发文量
98
期刊介绍: To advance and improve the radiologic aspects of emergency careTo establish Emergency Radiology as an area of special interest in the field of diagnostic imagingTo improve methods of education in Emergency RadiologyTo provide, through formal meetings, a mechanism for presentation of scientific papers on various aspects of Emergency Radiology and continuing educationTo promote research in Emergency Radiology by clinical and basic science investigators, including residents and other traineesTo act as the resource body on Emergency Radiology for those interested in emergency patient care Members of the American Society of Emergency Radiology (ASER) receive the Emergency Radiology journal as a benefit of membership!
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