Clinical Sciences Research Institute (University of Warwick), University Hospitals Coventry and Warwickshire, Coventry, UK.
Emerg Med J. 2011 May;28(5):378-82. doi: 10.1136/emj.2009.076414. Epub 2010 Jun 1.
Trauma remains a major cause of mortality and morbidity, particularly among young adults. A major trauma (whole-body) CT protocol based upon mechanism of injury was investigated in a busy emergency department.
Trauma patients presenting in two 3-month periods before and after the introduction of a major trauma CT protocol were identified. The mechanism of injury, Injury Severity Score, radiological imaging performed and injuries detected were recorded.
More eligible patients received major trauma CT scanning post-protocol than pre-protocol (87/114 (76%) vs 44/94 (47%)). There were no adverse effects attributable to major trauma CT. Seventeen injuries were detected post-protocol that would not have been detected had imaging been conducted based on clinical suspicion rather than mechanism of injury. In three cases an immediate intervention was required.
Our major trauma CT protocol, based on mechanism of injury, resulted in substantial changes in clinical management in a small number of patients without any increase in adverse events. However, it is not a substitute for clinical acumen in the initial assessment of trauma patients.
创伤仍然是导致死亡率和发病率的主要原因，尤其是在年轻人中。在一家繁忙的急诊科，我们研究了一种基于损伤机制的大型创伤（全身）CT 方案。
在引入大型创伤 CT 方案前后的两个 3 个月期间，确定了出现创伤的患者。记录了损伤机制、损伤严重程度评分、进行的影像学检查和发现的损伤。
与方案前相比，更多符合条件的患者接受了大型创伤 CT 扫描（87/114（76%）比 44/94（47%））。大型创伤 CT 没有造成任何不良影响。方案后发现了 17 处损伤，如果不是根据损伤机制而不是临床怀疑进行影像学检查，这些损伤就不会被发现。在三种情况下，需要立即进行干预。
我们的大型创伤 CT 方案基于损伤机制，在少数患者中导致了临床管理的重大变化，而没有任何不良事件的增加。然而，它不能替代创伤患者初始评估中的临床敏锐性。
