每年有6900万人患有创伤性脑损伤(TBI),TBI是蛛网膜下腔出血(SAH)的最常见原因。创伤性SAH(TSAH)已被描述为导致进行性神经系统恶化以及发病率和死亡率增加的不良预后因素。数量有限的研究,然而,评估创伤背景下SAH诊断和治疗的最新趋势。本范围审查的目的是了解有关TSAH诊断标准和管理的证据的范围和类型。这项范围审查是按照乔安娜·布里格斯研究所的范围审查方法进行的。审查包括成人SAH继发于创伤,其中孤立的TSAH(iTSAH)是指在没有任何其他创伤性影像学颅内病理的情况下存在SAH,和TSAH是指SAH的存在,可能或存在额外的创伤性影像学颅内病理。从每项研究中提取的数据包括研究目标,国家,方法论,人口特征,结果衡量标准,调查结果摘要,未来的指令。30项研究符合纳入标准。研究按主题分为五类:TSAH与轻度TBI(mTBI)相关,n=13),和严重TBI(n=3);临床管理和诊断(n=9);影像学检查(n=3);和动脉瘤性TSAH(n=1)。在30项研究中,两个来自低收入和中等收入国家(LMIC),不包括中国,几乎是一个高收入国家。与mTBI相关的TSAH患者临床恶化和手术干预的风险非常低,在考虑入住重症监护病房时应保守治疗。赫尔辛基和斯德哥尔摩计算机断层扫描评分系统,除了美国伤害量表,肌酐水平,年龄决策树,在预测结果和死亡时可能是有价值的工具。
Sixty-nine million people have a traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. A limited number of studies, however, evaluate recent trends in the diagnosis and management of SAH in the context of trauma. The objective of this scoping
review was to understand the extent and type of evidence concerning the diagnostic criteria and management of TSAH. This scoping
review was conducted following the Joanna Briggs Institute methodology for scoping reviews. The
review included adults with SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (mTBI), n = 13), and severe TBI (n = 3); clinical management and diagnosis (n = 9); imaging (n = 3); and aneurysmal TSAH (n = 1). Of the 30 studies, two came from a low- and middle-income country (LMIC), excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be treated conservatively when considering intensive care unit admission. The Helsinki and Stockholm computed tomography scoring systems, in addition to the American Injury Scale, creatinine level, age decision tree, may be valuable tools to use when predicting outcome and death.