Assistance Publique-Hôpitaux de Paris, Paris, France.
Eur Radiol. 2013 Aug;23(8):2146-55. doi: 10.1007/s00330-013-2798-x. Epub 2013 Mar 19.
To evaluate the accuracy of abdominal radiography (AXR) for the detection of residual cocaine packets by comparison with computed tomography (CT).
Over a 1-year period unenhanced CT was systematically performed in addition to AXR for pre-discharge evaluation of cocaine body packers. AXR and CT were interpreted independently by two radiologists blinded to clinical outcome. Patient and packet characteristics were compared between the groups with residual portage and complete decontamination.
Among 138 body packers studied, 14 (10 %) had one residual packet identified on pre-discharge CT. On AXR, at least one reader failed to detect the residual packet in 10 (70 %) of these 14 body packers. The sensitivity and specificity of AXR were 28.6 % (95 % CI: 8.4-58.1) and 100.0 % (95 % CI: 97.0-100.0) for reader 1 and 35.7 % (95 % CI: 12.8-64.9) and 97.6 % (95 % CI: 93.1-99.5) for reader 2. There were no significant patient or packet characteristics predictive of residual portage or AXR false negativity. All positive CT results were confirmed by delayed expulsion or surgical findings, while negative results were confirmed by further surveillance.
Given the poor performance of AXR, CT should be systematically performed to ensure safe hospital discharge of cocaine body packers.
• Both abdominal radiography and computed tomography can identify gastrointestinal cocaine packets. • Ten per cent of body packers had residual packets despite two packet-free stools. • Seventy per cent of these residual packets were missed on AXR. • No patient or packet characteristics predicted residual packets or AXR false negativity. • CT is necessary to ensure safe medical discharge of body packers.
通过与计算机断层扫描（CT）比较，评估腹部 X 线摄影（AXR）检测可卡因包残留的准确性。
在 1 年期间，对可卡因包裹体清除者进行出院前评估时，除了 AXR 之外，系统地进行了未增强 CT。两位放射科医生独立对 AXR 和 CT 进行解读，对临床结果不知情。比较了有残留包裹和完全清除的两组患者和包裹的特征。
在 138 名包裹体清除者中，14 名（10%）在出院前 CT 上发现了一个残留包裹。在 AXR 上，至少有一位读者在这 14 名包裹体清除者中的 10 名（70%）未能检测到残留包裹。读者 1 和读者 2 的 AXR 灵敏度和特异性分别为 28.6%（95%CI：8.4-58.1）和 100.0%（95%CI：97.0-100.0），读者 1 和读者 2 的敏感性和特异性分别为 35.7%（95%CI：12.8-64.9）和 97.6%（95%CI：93.1-99.5）。没有发现预测残留包裹或 AXR 假阴性的患者或包裹特征。所有阳性 CT 结果均通过延迟排出或手术证实，而阴性结果通过进一步监测证实。
鉴于 AXR 表现不佳，应系统进行 CT 检查以确保可卡因包裹体清除者安全出院。
腹部 X 线摄影和计算机断层扫描均可识别胃肠道可卡因包裹。
尽管有两便无包裹物，仍有 10%的包裹体清除者有残留包裹。
70%的这些残留包裹在 AXR 上漏诊。
没有患者或包裹特征可预测残留包裹或 AXR 假阴性。
CT 是确保包裹体清除者安全出院的必要手段。
