Schnüriger Beat, Inaba Kenji, Barmparas Galinos, Eberle Barbara M, Lustenberger Thomas, Lam Lydia, Talving Peep, Demetriades Demetrios
Division of Trauma and Surgical Critical Care, Los Angeles County Medical Center, University of Southern California, Los Angeles, California, USA.
J Trauma. 2010 Aug;69(2):302-7. doi: 10.1097/TA.0b013e3181bdcfaf.
The significance of serial white blood cell (WBC) counts in trauma patients with a suspected hollow viscus injury (HVI) is unknown. The purpose of this study was to examine the role of serial WBC counts in the diagnosis of a HVI.
After institutional review board approval, all injured patients admitted to a Level I trauma center from January 2003 to December 2007 with at least one WBC measurement were included in a retrospective analysis. The WBC profiles for patients with a HVI were compared against those without HVI. All WBC counts are reported as [x10(3)/microL].
The mean WBC count of the overall study population (n = 5,950) on admission was 11.6 +/- 5.3. Overall, 59.2% had an elevated WBC count on admission. A significant relationship between increasing Injury Severity Score and increasing WBC count on admission was found by linear regression. When comparing patients with HVI (n = 267) with patients without HVI (n = 5,683), no significant difference was found for admission WBC count. The highest WBC count within the first 24 hours for patients with HVI was 16.7 +/- 4.7. This was significantly higher than that for the 4,520 patients without any intraabdominal injury (13.0 +/- 5.2, adjusted p < 0.001). Penetrating injury, a concomitant severe thoracic trauma (chest Abbreviated Injury Scale value >or=3), and highest WBC count >or=20.0 in the first 24 hours were independent risk factors for HVI. A maximal WBC count <or=12.5 in the first 24 hours was independently associated with a lower incidence of HVI. The area under the receiver operating characteristic curve for the highest WBC count in the first 24 hours for predicting HVI was 0.723 (95% CI: 0.656-0.790).
Multiple variables likely impact the WBC count in trauma patients. WBC count elevation on admission is nonspecific and does not predict the presence of a HVI. With serial measurements, WBC counts >or=20.0 are independently associated with a HVI, whereas counts <or=12.5 rule against the presence of HVI. However, the sensitivity of these cutoff values to predict a HVI is poor. The diagnostic value of serial WBC counts for predicting a HVI within the first 24 hours after trauma is very limited.
对于疑似中空脏器损伤（HVI）的创伤患者，连续白细胞（WBC）计数的意义尚不清楚。本研究的目的是探讨连续白细胞计数在HVI诊断中的作用。
经机构审查委员会批准，对2003年1月至2007年12月入住一级创伤中心且至少有一次白细胞测量值的所有受伤患者进行回顾性分析。将HVI患者的白细胞谱与无HVI患者的白细胞谱进行比较。所有白细胞计数均报告为[×10³/微升]。
整个研究人群（n = 5950）入院时的平均白细胞计数为11.6±5.3。总体而言，59.2%的患者入院时白细胞计数升高。通过线性回归发现损伤严重程度评分增加与入院时白细胞计数增加之间存在显著关系。将HVI患者（n = 267）与无HVI患者（n = 5683）进行比较时，入院时白细胞计数无显著差异。HVI患者在最初24小时内的最高白细胞计数为16.7±4.7。这显著高于4520例无腹腔内损伤患者的白细胞计数（13.0±5.2，校正p < 0.001）。穿透伤、伴有严重胸部创伤（胸部简明损伤量表值≥3）以及最初24小时内最高白细胞计数≥20.0是HVI的独立危险因素。最初24小时内最大白细胞计数≤12.5与较低的HVI发生率独立相关。用于预测HVI的最初24小时内最高白细胞计数的受试者工作特征曲线下面积为0.723（95%CI：0.656 - 0.790）。
多种变量可能影响创伤患者的白细胞计数。入院时白细胞计数升高是非特异性的，不能预测HVI的存在。通过连续测量，白细胞计数≥20.0与HVI独立相关，而计数≤12.5则排除HVI的存在。然而，这些临界值预测HVI的敏感性较差。创伤后最初24小时内连续白细胞计数对预测HVI的诊断价值非常有限。
