Treatment of Blunt Cerebrovascular Injury - A Systematic Review and Meta-Analysis, Multicenter Retrospective Review, and Protocol for a Feasibility Randomized Controlled Trial
Notice bibliographique
Résumé
Blunt cerebrovascular injury (BCVI) is an often-overlooked clinical problem that can result in stroke and cause devastating, potentially permanent, neurologic disabilities in young and otherwise healthy trauma patients. Early diagnosis and treatment of BCVI can reduce the risk of stroke and prevent disability, however, treatment also carries a risk of bleeding complications. More research is needed to understand the optimal management strategy to reduce the risk of stroke while minimizing bleeding complications.\nThe aim of this thesis is to review and critically appraise the literature to better understand the efficacy of various treatment strategies in preventing stroke following BCVI, evaluate current practice patterns and patient outcomes at Canadian Level I Trauma Centers, and create a feasibility randomized controlled trial protocol to assess practicability of a future randomized control trial determining the optimal dose of antiplatelet therapy in the treatment of BCVI.\nSystematic review and meta-analysis of existing literature revealed a slightly lower risk of stroke with the use of antiplatelets compared to anticoagulants (4.5% vs. 5.2%; OR 0.57; 95% CI 0.33 – 0.96, p = 0.04), although there was no difference in stroke rate when evaluating the use of specific agents, acetylsalicylic acid (ASA) vs. heparin (OR 0.43; 95% CI 0.15 – 1.20, p = 0.11). Bleeding complications were significantly higher with the use of anticoagulants and led to more severe bleeding requiring invasive intervention, suggesting better tolerance of antiplatelets in the trauma population. Retrospective review of trauma registries at two Canadian Level I Trauma Centers revealed that patients were more likely to develop stroke after BCVI if they were injured as a result of a motor vehicle collision (MVC), had a lower initial Glasgow Coma Scale (GCS) and higher Injury Severity Scale (ISS), did not meet Denver screening criteria, or had carotid artery injuries. Patients who suffered a stroke were more likely to require intensive care. Treatment interruptions or delays were not associated with increased risk of stroke, and the dose of therapy (81 mg ASA vs. 325 mg ASA) was not independently associated with an increase in stroke rate after adjustment for initial GCS, injury location, and grade of injury (OR 2.244; 95% CI 0.660-7.628).\nCurrent research suggests that early detection and treatment of BCVI can significantly reduce the risk of stroke. ASA has shown similar efficacy as heparin for stroke risk reduction but was associated with less bleeding complications. Currently, the optimal dose of ASA is still unknown. Data from retrospective reviews suggests that there is no difference in stroke rates when using low-dose (81 mg) vs. high-dose (325 mg) ASA but no experimental studies exist to evaluate this question. A randomized controlled trial is required to further assess different doses of ASA to determine the optimal dose that reduces the risk of stroke while minimizing bleeding complications.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,045 | 0,060 |
| Méta-épidémiologie (sens strict) | 0,004 | 0,003 |
| Méta-épidémiologie (sens large) | 0,018 | 0,023 |
| Bibliométrie | 0,005 | 0,006 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,006 | 0,004 |
| Science ouverte | 0,004 | 0,003 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,031 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».