Inaba Kenji, Munera Felipe, McKenney Mark, Schulman Carl, de Moya Marc, Rivas Luis, Pearce Amelia, Cohn Stephen
Division of Trauma and Critical Care, LAC+USC Medical Center, Los Angeles, CA 90033, USA.
J Trauma. 2006 Apr;60(4):915-20. doi: 10.1097/01.ta.0000196926.79065.6e.
Accurate screening of the thoracolumbar spine (TLS) remains problematic in the care of trauma patients. The current standard of care for TLS screening is not clearly defined. In trauma patients undergoing computed tomography (CT) of the chest and or abdomen, compelling supportive evidence for reformatting and reusing this CT data to clear the thoracolumbar spine has accumulated over the last 3 years. The objective of this review was to identify and review all published studies comparing reformatted CT to traditional plain radiography for TLS clearance.
A Medline search for all English language articles published on this subject since 1980 identified seven studies. Each was classified according to the levels of evidence classification of the Agency for Health Care Policy and Research. The methodology of each study was reviewed for the CT protocol, utilization of radiologist blinding and whether historical dictated reports or de novo image readings were used for comparison. The sensitivity and specificity of each study and the gold standard utilized in its calculation was noted. Where available, detailed information regarding the missed injuries and their clinical relevance was abstracted for each study.
All evaluated studies demonstrated superior sensitivity and interobserver variability for reformatted CT compared with plain radiographic screening. CT was also more accurate in localizing, classifying, and delineating the age, bony intrusion, and soft-tissue damage associated with the fracture. For studies with time-motion components, a protocol utilizing CT clearance was not only more accurate but faster and more economical. Screening with reformatted visceral CT data required no additional scan time or radiation exposure.
The evidence to date demonstrates the superior sensitivity of reformatted visceral CT for detecting thoracolumbar spine injury. With no further patient movement, radiation exposure, cost, or time, trauma patients undergoing visceral CT can have their thoracolumbar spine promptly evaluated. Further prospective evaluation of the CT protocols to optimize visualization of both the viscera and the bone is warranted.
在创伤患者的治疗中，准确筛查胸腰椎（TLS）仍然存在问题。目前TLS筛查的护理标准尚未明确界定。在过去3年中，对于接受胸部和/或腹部计算机断层扫描（CT）的创伤患者，重新格式化和重新使用该CT数据以排除胸腰椎损伤的有力支持证据不断积累。本综述的目的是识别和回顾所有已发表的比较重新格式化CT与传统X线平片用于TLS排除的研究。
对自1980年以来发表的关于该主题的所有英文文章进行Medline检索，共识别出7项研究。每项研究均根据医疗保健政策和研究机构的证据分类水平进行分类。对每项研究的方法进行审查，包括CT方案、放射科医生盲法的使用情况以及是使用历史记录报告还是重新进行图像解读进行比较。记录每项研究的敏感性和特异性以及计算中使用的金标准。如有可用信息，提取每项研究中关于漏诊损伤及其临床相关性的详细信息。
所有评估研究均表明，与X线平片筛查相比，重新格式化CT具有更高的敏感性和观察者间变异性。CT在定位、分类以及描绘与骨折相关的年龄、骨侵入和软组织损伤方面也更准确。对于具有时间-动作成分的研究，采用CT排除方案不仅更准确，而且更快、更经济。用重新格式化的内脏CT数据进行筛查无需额外的扫描时间或辐射暴露。
迄今为止的证据表明，重新格式化的内脏CT在检测胸腰椎损伤方面具有更高的敏感性。无需患者进一步移动、辐射暴露、花费或时间，接受内脏CT检查的创伤患者即可迅速对其胸腰椎进行评估。有必要对CT方案进行进一步的前瞻性评估，以优化内脏和骨骼的可视化。
