Geyer Lucas L, Körner M, Linsenmaier U, Wirth S, Reiser M F, Meindl T
Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
Acta Radiol. 2014 May;55(4):486-94. doi: 10.1177/0284185113499559. Epub 2013 Aug 22.
Beside its value during the initial trauma work-up (focused assessment with sonography for trauma), ultrasound (US) is recommended for early follow-up examinations of the abdomen in multiple injured patients. However, multidetector CT (MDCT) has proven to reliably diagnose traumatic lesions of abdominal organs, to depict their extent, and to assess their clinical relevance.
To evaluate the diagnostic impact of follow-up US studies after MDCT of the abdomen and to identify possible clinical parameters indicating the need of a follow-up US.
During a 30-month period, patients with suspected multiple trauma were allocated. Patients with admission to the ICU, an initial abdominal MDCT scan, and an US follow-up examination after 6 and 24 h were included. Two patient cohorts were defined: patients with normal abdominal MDCT (group 1), patients with trauma-related pathologic abdominal MDCT (group 2). In all patients, parameters indicating alteration of vital functions or hemorrhage within the first 24 h were obtained by reviewing the medical charts.
Forty-four of 193 patients were included: 24 were categorized in group 1 (mean age, 41.1 years; range, 21-90 years), 20 in group 2 (mean age, 36.6 years; range, 16-71 years). In group 1, US did not provide new information compared to emergency MDCT. In group 2, there were no contradictory 6- and 24-h follow-up US findings. In patients with positive MDCT findings and alterations of clinical parameters, US did not detect progression of a previously diagnosed pathology or any late manifestation of such a lesion. In none of the patients with negative abdominal MDCT and pathological clinical parameters US indicated an abdominal injury.
Routine US follow-up does not yield additional information after abdominal trauma. In patients with MDCT-proven organ lesions, follow-up MDCT should be considered if indicated by abnormal clinical and/or laboratory findings.
除了在初始创伤评估（创伤超声重点评估）期间具有价值外，超声（US）还被推荐用于对多发伤患者进行腹部早期随访检查。然而，多排螺旋CT（MDCT）已被证明能够可靠地诊断腹部器官的创伤性病变，描绘其范围，并评估其临床相关性。
评估腹部MDCT后随访超声检查的诊断影响，并确定可能提示需要进行随访超声检查的临床参数。
在30个月期间，对疑似多发伤患者进行了分配。纳入入住重症监护病房、进行了初始腹部MDCT扫描以及在6小时和24小时后进行了超声随访检查的患者。定义了两个患者队列：腹部MDCT正常的患者（第1组），腹部MDCT有创伤相关病理改变的患者（第2组）。在所有患者中，通过查阅病历获取在最初24小时内表明生命功能改变或出血的参数。
193例患者中有44例被纳入：第1组24例（平均年龄41.1岁；范围21 - 90岁），第2组20例（平均年龄36.6岁；范围16 - 71岁）。在第1组中，与急诊MDCT相比，超声未提供新信息。在第2组中，6小时和24小时的随访超声检查结果没有矛盾。在MDCT结果阳性且临床参数改变的患者中，超声未检测到先前诊断病变的进展或此类病变的任何晚期表现。在腹部MDCT阴性且临床参数异常的患者中，超声均未提示腹部损伤。
腹部创伤后常规超声随访不会产生额外信息。在MDCT证实有器官病变的患者中，如果临床和/或实验室检查结果异常，应考虑进行随访MDCT检查。
