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创伤全腹扫描:你还发现了什么?

The trauma pan scan: what else do you find?

作者信息

Baugh Katherine A, Weireter Leonard J, Collins Jay N

机构信息

Eastern Virginia Medical School, Norfolk, Virginia, USA.

出版信息

Am Surg. 2014 Sep;80(9):855-9.

Abstract

The objective of this study was to investigate the prevalence of incidental findings in pan-computed tomography (CT) scans of trauma patients and the communication of significant findings requiring follow-up to the patient. A retrospective chart review of adult trauma patients was performed during the period of January 1, 2011, to August 31, 2011. During that period, 990 patient charts were examined and 555 charts were selected based on the inclusion criteria of a pan-CT scan including the head, neck, abdomen/pelvis, and chest. Patient demographics such as age, gender, mechanism of injury, and Injury Severity Score were collected. Nontraumatic incidental findings were analyzed to establish the prevalence of incidental findings among trauma patients. Discharge summaries were also examined for follow-up instructions to determine the effectiveness of communication of the significant findings. Between the 555 pan-CT scans (1759 total scans), 1706 incidental findings were identified with an incidence of 3.1 incidental findings per patient and with the highest concentration of findings occurring in the abdomen/pelvis. The majority of findings were benign including simple renal cysts with a prevalence of 7.7 per cent. However, 282 significant findings were identified that were concerning for possible malignancy or those requiring further evaluation, the most common of which were lung nodules, which accounted for 21.6 per cent of significant findings. However, only 32.6 per cent of significant findings were documented as reported to the patient. With the use of pan scans on trauma patients, many incidental findings have been identified to the benefit of the patient. The majority of these are clinically insignificant; however, only 32.6 per cent of potentially significant findings were communicated to the patient. The advantage of early detection comes from proper communication and this study demonstrates that there could be improvement in conveying findings to the patient.

摘要

本研究的目的是调查创伤患者全腹部计算机断层扫描(CT)中偶然发现的发生率,以及将需要随访的重要发现告知患者的情况。对2011年1月1日至2011年8月31日期间的成年创伤患者进行了回顾性病历审查。在此期间,检查了990份患者病历,并根据包括头部、颈部、腹部/骨盆和胸部的全腹部CT扫描纳入标准选择了555份病历。收集了患者的人口统计学数据,如年龄、性别、损伤机制和损伤严重程度评分。对非创伤性偶然发现进行分析,以确定创伤患者中偶然发现的发生率。还检查了出院小结中的随访指示,以确定重要发现告知的有效性。在555次全腹部CT扫描(共1759次扫描)中,发现了1706个偶然发现,每位患者的偶然发现发生率为3.1个,且发现最集中在腹部/骨盆。大多数发现为良性,包括单纯肾囊肿,患病率为7.7%。然而,确定了282个重要发现,这些发现可能与恶性肿瘤有关或需要进一步评估,其中最常见的是肺结节,占重要发现的21.6%。然而,只有32.6%的重要发现记录为已告知患者。通过对创伤患者进行全腹部扫描,发现了许多偶然发现,这对患者有益。其中大多数在临床上无意义;然而,只有32.6%的潜在重要发现告知了患者。早期发现的优势来自于恰当的告知,本研究表明在向患者传达发现方面可能需要改进。

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