Rieger Michael, Czermak Benedikt, El Attal Rene, Sumann Günther, Jaschke Werner, Freund Martin
Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
J Trauma. 2009 Mar;66(3):648-57. doi: 10.1097/TA.0b013e31816275f3.
The objective of this study was to assess time management and diagnostic quality when using a 64-multidetector-row computed tomography (MDCT) whole-body scanner to evaluate polytraumatized patients in an emergency department.
Eighty-eight consecutive polytraumatized patients with injury severity score (ISS) > or = 18 (mean ISS = 29) were included in this study. Documented and evaluated data were crash history, trauma mechanism, number and pattern of injuries, injury severity, diagnostics, time flow, and missed diagnoses. Data were stored in our hospital information system. Seven time intervals were evaluated. In particular, attention was paid to the "acquisition interval," the "reformatting and evaluation time" as well as the "CT time" (time from CT start to preliminary diagnosis). A standardized whole-body CT was performed. The acquired CT data together with automatically generated multiplanar reformatted images ("direct MPR") were transferred to a 3D rendering workstation. Diagnostic quality was determined on the basis of missed diagnoses. Head-to-toe scout images were possible because volume coverage was up to 2 m. Experienced radiologists at an affiliated workstation performed radiologic evaluation of the acquired datasets immediately after acquisition.
The "acquisition interval" was 12 minutes +/- 4.9 minutes, the "reformatting and evaluation interval" 7.0 minutes +/- 2.1 minutes, and the "CT time" 19 minutes +/- 6.1 minutes. Altogether, 7 of 486 lesions were recognized but not communicated in the "reformatting and evaluation interval", and 10 injuries were initially missed and detected during follow-up.
This study indicates that 64-MDCT saves time, especially in the "reformatting and evaluation interval." Diagnostic quality is high, as reflected by the small number of missed diagnoses.
本研究的目的是评估在急诊科使用64排多层螺旋计算机断层扫描（MDCT）全身扫描仪评估多发伤患者时的时间管理和诊断质量。
本研究纳入了88例连续的多发伤患者，损伤严重度评分（ISS）≥18（平均ISS = 29）。记录并评估的数据包括事故史、创伤机制、损伤的数量和类型、损伤严重程度、诊断、时间流程和漏诊情况。数据存储在我院信息系统中。评估了七个时间间隔。特别关注“采集间隔”、“重新格式化和评估时间”以及“CT时间”（从CT开始到初步诊断的时间）。进行了标准化的全身CT扫描。采集到的CT数据以及自动生成的多平面重组图像（“直接MPR”）被传输到三维渲染工作站。诊断质量根据漏诊情况确定。由于容积覆盖范围达2米，因此可以获得从头到脚的定位像。附属工作站的经验丰富的放射科医生在采集后立即对采集到的数据集进行放射学评估。
“采集间隔”为12分钟±4.9分钟，“重新格式化和评估间隔”为7.0分钟±2.1分钟，“CT时间”为19分钟±6.1分钟。在“重新格式化和评估间隔”期间，486处损伤中有7处被识别但未报告，10处损伤最初漏诊，在随访期间被发现。
本研究表明，64排MDCT节省时间，尤其是在“重新格式化和评估间隔”。漏诊数量少反映出诊断质量高。
