Pryor John P, Braslow Benjamin, Reilly Patrick M, Gullamondegi Oscar, Hedrick Joseph H, Schwab C William
Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania School of Medicine, PA 19104, USA.
J Trauma. 2005 Jul;59(1):102-4. doi: 10.1097/01.ta.0000171455.66437.de.
Although the traditional role of radiology in trauma care has been diagnostic, therapeutic interventional radiology (IR) techniques have now become essential in the management of many injuries. We hypothesized that IR has evolved at our institution over the last decade from a largely diagnostic to a more therapeutic role in the care of the injured patient.
Demographic information, computed tomographic scans of the chest and abdomen, and angiographic procedures (APs) performed within 48 hours of admission were reviewed in all patients evaluated at a Level I trauma center for the periods 1993 to 1995 and 2000 to 2002. All APs performed with the intent to embolize, stent, or insert a device into a vessel were designated as therapeutic. Analysis by means of chi provided between-group comparisons for questions of interest and the Student's t test was used for comparison of means.
A total of 4,750 patients were reviewed, 1,677 from the time period 1993 to 1995 and 3,073 from the period 2000 to 2002. Overall injury severity as measured by the Injury Severity Score (ISS) was similar in both groups (9.6 vs. 9.9, p = not significant). The number of angiograms obtained decreased significantly from 7.1% to 4.0% of all patients (p < 0.01). Concurrently, the fraction of all angiograms that were considered therapeutic rose from 10% to 22% (p < 0.05). The overall number of aortic arch angiograms decreased over time (from 3.6% to 0.9%, p < 0.01), and the percentage of positive examinations increased from 5.0% to 21.4%. In comparison, the number of computed tomographic scans of the chest increased from 1.6% of all patients to 10.8% (p < 0.01).
Axial imaging studies are being used more frequently to screen trauma patients for injury. Concurrently, diagnostic APs are less frequently performed but are more frequently positive. In addition, IR studies are increasingly focused on therapeutic intervention. IR program development and support is an integral aspect of modern trauma care. These findings have prompted our institution to equip the IR suite to function as an active resuscitation area similar to the trauma bay and intensive care unit.
尽管放射学在创伤护理中的传统作用一直是诊断，但治疗性介入放射学（IR）技术如今在许多损伤的管理中已变得至关重要。我们推测，在过去十年中，IR在我们机构已从主要的诊断角色演变为在受伤患者护理中发挥更具治疗性的作用。
回顾了1993年至1995年以及2000年至2002年期间在一级创伤中心接受评估的所有患者的人口统计学信息、胸部和腹部的计算机断层扫描以及入院后48小时内进行的血管造影检查（APs）。所有旨在栓塞、置入支架或向血管内插入装置的APs均被指定为治疗性操作。采用卡方检验进行组间比较以分析感兴趣的问题，采用学生t检验进行均值比较。
共回顾了4750例患者，其中来自1993年至1995年期间的有1677例，来自2000年至2002年期间的有3073例。两组患者的损伤严重程度评分（ISS）所衡量的总体损伤严重程度相似（分别为9.6和9.9，p = 无显著差异）。血管造影检查的数量从占所有患者的7.1%显著下降至4.0%（p <
0.01）。与此同时，所有血管造影检查中被视为治疗性的比例从10%升至22%（p < 0.05）。主动脉弓血管造影检查的总数随时间减少（从3.6%降至0.9%，p < 0.01），阳性检查的百分比从5.0%增至21.4%。相比之下，胸部计算机断层扫描的数量从占所有患者的1.6%增至10.8%（p < 0.01）。
轴向成像研究越来越频繁地用于筛查创伤患者是否受伤。与此同时，诊断性APs的执行频率降低，但阳性率更高。此外，IR研究越来越侧重于治疗性干预。IR项目的开发和支持是现代创伤护理不可或缺的一部分。这些发现促使我们机构将IR套房配备成一个类似创伤病房和重症监护病房的活跃复苏区域。
