Trauma Unit, Department of Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Emerg Med J. 2010 Jul;27(7):522-5. doi: 10.1136/emj.2009.078519. Epub 2010 Apr 1.
Several guidelines advocate multiple chest x-rays during primary resuscitation of trauma patients. Some local hospital protocols include a repeat x-ray before leaving the trauma resuscitation room (TR). The purpose of this study was to determine the value of routine repeat x-rays.
One-year data of all radiological imaging in the TR were prospectively collected for all patients presenting to the TR of the hospital. The x-rays were counted and assessed and the findings were classified as either 'new injury detected', 'presence of intervention devices' or 'deterioration of previously detected injury'.
A total of 674 patients were included. More than 75% had two x-rays. Eight (2.1%) new injuries without clinical relevance were found on the repeat x-ray after an initial normal x-ray. 61 patients (9%) had a repeat x-ray to verify the effect of an intervention or position of devices. In 28 patients (22%) with two abnormal x-rays, newly diagnosed injuries (n=9) or deterioration of known injuries (n=19) were found. In 411 patients (81%) the results of the repeat x-ray had no clinical consequences.
This study indicates that routine repeat chest x-rays can be omitted in trauma patients whose initial chest x-ray is normal.
多项指南主张在创伤患者的初级复苏过程中进行多次胸部 X 光检查。一些当地医院的方案包括在离开创伤复苏室 (TR) 前重复拍摄 X 光片。本研究的目的是确定常规重复 X 光片的价值。
前瞻性收集所有在医院 TR 接受治疗的患者的所有 TR 放射影像学数据。对 X 光片进行计数和评估，并将结果分为“新发现损伤”、“存在干预设备”或“先前发现损伤恶化”。
共纳入 674 例患者。超过 75%的患者拍摄了两张 X 光片。首次正常 X 光片后，在重复 X 光片上发现了 8 例（2.1%）无临床意义的新发损伤。61 例（9%）进行重复 X 光片检查以验证干预措施的效果或设备的位置。在 28 例（22%）两次异常 X 光片的患者中，新诊断的损伤（n=9）或已知损伤的恶化（n=19）。在 411 例（81%）患者中，重复 X 光片的结果无临床后果。
本研究表明，对于初始胸部 X 光片正常的创伤患者，可以省略常规重复胸部 X 光片检查。
