دورية أكاديمية
Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation
| العنوان: | Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation |
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| المؤلفون: | A Pandor, S Goodacre, S Harnan, M Holmes, A Pickering, P Fitzgerald, A Rees, M Stevenson |
| المصدر: | Health Technology Assessment, Vol 15, Iss 27 (2011) |
| بيانات النشر: | NIHR Journals Library, 2011. |
| سنة النشر: | 2011 |
| المجموعة: | LCC:Medical technology |
| مصطلحات موضوعية: | management strategy, minor head injury, diagnostic accuracy, computerised tomography, skull radiography, cost-effectiveness, systematic review, economic evaluation, Medical technology, R855-855.5 |
| الوصف: | Background: Patients with minor head injury [Glasgow Coma Scale (GCS) score 13–15] have a small but important risk of intracranial injury (ICI) that requires early identification and neurosurgical treatment. Diagnostic assessment can use either a clinical decision rule or unstructured assessment of individual clinical features to identify those who are at risk of ICI and in need of computerised tomography (CT) scanning and/or hospital admission. Selective use of CT investigations helps minimise unnecessary radiation exposure and resource use, but can lead to missed opportunities to provide early treatment for ICI. Objectives: To determine the diagnostic accuracy of decision rules, individual clinical characteristics, skull radiography and biomarkers, and the clinical effectiveness and cost-effectiveness of diagnostic management strategies for minor head injury (MHI). Data sources: Several electronic databases [including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and The Cochrane Library] were searched from inception to April 2009 (updated searches to March 2010 were conducted on the MEDLINE databases only). Searches were supplemented by hand-searching relevant articles (including citation searching) and contacting experts in the field. For each of the systematic reviews the following studies were included (1) cohort studies of patients with MHI in which a clinical decision rule or individual clinical characteristics (including biomarkers and skull radiography) were compared with a reference standard test for ICI or need for neurosurgical intervention and (2) controlled trials comparing alternative management strategies for MHI. Review methods: Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool (for the assessment of diagnostic accuracy) or criteria recommended by the Effective Practice and Organisation of Care Review Group (for the assessment of management practices). Where sufficient data existed, a meta-analysis was undertaken to generate pooled estimates of diagnostic parameters. A decision-analysis model was developed using Simul8 2008 Professional software (Simul8 Corporation, Boston, MA, USA) to estimate the costs and quality-adjusted life-years (QALYs) accrued by management strategies for MHI. The model took a lifetime horizon and NHS perspective. Estimates of the benefits of early treatment, harm of radiation exposure and long-term costs were obtained through literature reviews. Initial analysis was deterministic, but probabilistic sensitivity analysis was also performed. Secondary analyses were undertaken to explore the trade-off between sensitivity and specificity in diagnostic strategies and to determine the cost-effectiveness of scenarios involving hospital admission. Results: The literature searches identified 8003 citations. Of these, 93 full-text papers were included for the assessment of diagnostic accuracy and one for the assessment of management practices. The quality of studies and reporting was generally poor. The Canadian CT Head Rule (CCHR) was the most widely validated adult rule, with sensitivity of 99–100% and 80–100% for neurosurgical and any ICI, respectively (high- or medium-risk criteria), and specificity of 39–51%. Rules for children had high sensitivity and acceptable specificity in derivation cohorts, but limited validation. Depressed, basal or radiological skull fracture and post-traumatic seizure (PTS) [positive likelihood ratio (PLR) > 10]; focal neurological deficit, persistent vomiting, decrease in GCS and previous neurosurgery (PLR 5–10); and fall from a height, coagulopathy, chronic alcohol use, age > 60 years, pedestrian motor vehicle accident (MVA), any seizure, undefined vomiting, amnesia, GCS 10), coagulopathy, PTS and previous neurosurgery (PLR 5–10), visual symptoms, bicycle and pedestrian MVA, any seizure, loss of consciousness, vomiting, severe or persistent headache, amnesia, GCS |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 1366-5278 2046-4924 |
| Relation: | https://doaj.org/toc/1366-5278; https://doaj.org/toc/2046-4924 |
| DOI: | 10.3310/hta15270 |
| URL الوصول: | https://doaj.org/article/1490909f96754267957d9819607e8ddc |
| رقم الأكسشن: | edsdoj.1490909f96754267957d9819607e8ddc |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text Finder | تدمد: | 13665278 20464924 |
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| DOI: | 10.3310/hta15270 |