胸部 X 光片和腹部计算机断层扫描在识别外伤性胸部损伤中的作用。
Ability of a chest X-ray and an abdominal computed tomography scan to identify traumatic thoracic injury.
机构信息
Division of Trauma, Critical Care, Burn and Acute Care Surgery, Department of Surgery, University of California Irvine Medical Center, CA, USA.
出版信息
Am J Surg. 2010 Dec;200(6):741-4; discussion 744-5. doi: 10.1016/j.amjsurg.2010.08.004.
OBJECTIVE
Our objective was to show that a chest X-ray (CXR) and an abdominal computed tomography (CT) scan are sufficient to identify most clinically significant thoracic injuries in trauma patients, rendering the thoracic CT scan useful in only a subset of patients.
METHODS
A retrospective study identified thoracic injuries in 374 trauma patients evaluated with a CXR, a thoracic CT scan, and an abdominal CT scan. Injuries seen on the initial CXR versus those seen on a CT scan only (occult) were identified and assessed for clinical relevance.
RESULTS
An abdominal CT scan identified 65% (15/23) of occult pneumothoraces, 100% (25/25) of occult hemothoraces, 64% (18/28) of occult pulmonary contusions, and 58% (18/31) of occult rib fractures. No occult pneumothoraces seen on the thoracic CT scan alone required tube thoracostomy.
CONCLUSIONS
Our pilot study suggests that a CXR and an abdominal CT scan will identify most occult intrathoracic injuries. Reserving a thoracic CT scan for patients with an abnormal CXR or high-risk mechanism could safely reduce cost and radiation exposure while still diagnosing significant thoracic injuries.
目的
本研究旨在表明，胸部 X 光（CXR）和腹部计算机断层扫描（CT）足以识别创伤患者大多数具有临床意义的胸部损伤，仅对一部分患者有用胸部 CT 扫描。
方法
回顾性研究确定了 374 例接受 CXR、胸部 CT 扫描和腹部 CT 扫描评估的创伤患者的胸部损伤。比较初始 CXR 与仅 CT 扫描（隐匿性）所见的损伤，并评估其临床相关性。
结果
腹部 CT 扫描发现 23 例隐匿性气胸中的 65%（15/23）、25 例隐匿性血胸中的 100%（25/25）、28 例隐匿性肺挫伤中的 64%（18/28）和 31 例隐匿性肋骨骨折中的 58%（18/31）。单独进行胸部 CT 扫描未见隐匿性气胸需要进行胸腔引流。
结论
我们的初步研究表明，CXR 和腹部 CT 扫描可识别大多数隐匿性的胸部损伤。对于 CXR 异常或高风险机制的患者保留进行胸部 CT 扫描，可以安全地降低成本和辐射暴露，同时仍可诊断出重要的胸部损伤。
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