Beck David, Marley Robert, Salvator Ann, Muakkassa Farid
Departments of Trauma, Akron General Medical Center, Akron, Ohio 44307, USA.
J Trauma. 2004 Aug;57(2):296-300. doi: 10.1097/01.ta.0000130612.60661.c3.
CT scans are often used in the evaluation of blunt trauma patients. Many scans are negative. Clinical predictors of positive abdominal CT scans would be beneficial in patient care.
A prospective study of 213 patients at a Level I trauma center presenting with blunt trauma who underwent abdominal CT scan. Indications for CT scan were analyzed statistically, using univariate and multivariate models.
Univariate chi2 tests showed abnormal pelvis x-ray (p = 0.0002) and an intubated patient (p = 0.03) were predictors of a positive CT scan. When subjected to multivariate logistic regression, these two indications were significant predictors of a positive CT scan, abnormal pelvis x-ray (p = 0.0005, OR=6.6, 95% CI), and an intubated patient (p = 0.02, OR=2.6, 95% CI). Univariate chi2 tests also showed that alcohol intoxication was statistically significant predictor of a negative CT scan (p = 0.03).
Our data suggest that an abnormal pelvis x-ray and intubation are significant risk factors for a positive CT scan. Alcohol intoxication, mechanism of injury, and unreliable examination, without other associated indication for a scan, may warrant further study.
CT扫描常用于钝性创伤患者的评估。许多扫描结果为阴性。腹部CT扫描阳性的临床预测指标对患者护理有益。
对一家一级创伤中心的213例钝性创伤患者进行前瞻性研究，这些患者均接受了腹部CT扫描。使用单变量和多变量模型对CT扫描的指征进行统计学分析。
单变量卡方检验显示，骨盆X光片异常（p = 0.0002）和插管患者（p = 0.03）是CT扫描阳性的预测指标。进行多变量逻辑回归分析时，这两个指征是CT扫描阳性的显著预测指标，即骨盆X光片异常（p = 0.0005，OR = 6.6，95%置信区间）和插管患者（p = 0.02，OR = 2.6，95%置信区间）。单变量卡方检验还显示，酒精中毒是CT扫描阴性的统计学显著预测指标（p = 0.03）。
我们的数据表明，骨盆X光片异常和插管是CT扫描阳性的显著危险因素。酒精中毒、损伤机制和检查结果不可靠，若无其他相关的扫描指征，可能值得进一步研究。
