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Citation
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Nassiri F, Badhiwala JH, Witiw CD, Mansouri A, Davidson B, Almenawer SA, Lipsman N, Da Costa L, Pirouzmand F, Nathens AB. J. Trauma Acute Care Surg. 2017; 83(4): 725-731. |
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Affiliation
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1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto Ontario, Canada 2Division of Neurosurgery, Sunnybrook Health Sciences Center, Toronto Ontario, Canada 3Division of Neurosurgery, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada 4Division of General Surgery and Trauma, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. |
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Abstract
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BACKGROUND: The rates of clinical and radiographic progression, and need for neurosurgical intervention in patients with isolated traumatic subarachnoid hemorrhage (itSAH) after mild traumatic brain injury (mTBI, GCS 13-15) has not been well established.
OBJECTIVE: To review the evidence regarding patient outcomes after mTBI with itSAH DATA SOURCES: MEDLINE, EMBASE, Web of Science, Google Scholar and the Cochrane Library STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Electronic databases were searched for human studies without language restrictions from January 2000 to February 2017. Studies of any design (excluding review articles and case series) that included patients with itSAH and initial GCS 13-15 that specifically reported on prognosis as it related to the incidences of: need for neurosurgical intervention on presentation to hospital, radiographic progression, neurological deterioration, eventual need for neurosurgical intervention, and/or mortality. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently extracted the data according to a predefined protocol. The proportions of patients who had the outcomes of interest were pooled using random-effects model. The quality of included studies was assessed using the methodological index for non-randomized studies scale.
RESULTS: Thirteen studies reporting on 15327 patients met inclusion criteria and outcomes were pooled where available. No patient required neurosurgical intervention on presentation to hospital and the incidence of need for eventual neurosurgical intervention was 0.0017% (95%CI 0% - 0.39%). Moreover, the pooled analyses for all patients with available data showed an incidence of 5.76% (95%CI 1.18%-12.94%) for radiographic progression, 0.75% (95%CI 0%- 2.39%) for neurological deterioration, and 0.60% (95%CI 0.09% -1.41%) for mortality. Only one patient had died due to neurological injury. LIMITATIONS: Lack of randomized trials and paucity of prospective studies.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: These patients experience very low rates of radiographic progression and neurological deterioration and rarely require neurosurgical intervention or die due to neurological injury. LEVEL OF EVIDENCE: Meta-analysis, level III.
Language: en |