Shakerian Rose, Thomson Benjamin N, Judson Rodney, Skandarajah Anita R
From the Department of General Surgical Specialties (R.S., B.N.T., R.J., A.R.S.), and Trauma Service (R.S., B.N.T., R.J., A.R.S.), The Royal Melbourne Hospital; and Department of Surgery (R.S., B.N.T., R.J., A.R.S.), The University of Melbourne, Parkville, Victoria, Australia.
J Trauma Acute Care Surg. 2015 Jan;78(1):88-93. doi: 10.1097/TA.0000000000000497.
The Royal Melbourne Hospital is a Level 1 adult trauma center, and due to its colocation with The Royal Women's Hospital, it functions as the state's major obstetric trauma center. Obstetric trauma guidelines have been established to facilitate management of pregnant patients, yet adherence to these recommendations has not been evaluated. The aim of this study was to assess compliance with recommended imaging guidelines in obstetric trauma patients.
The prospectively collated trauma registry at Royal Melbourne Hospital was used to identify obstetric trauma presentations to the emergency department from January to December 2012. Demographics, mechanism of injury, clinical examination findings, and the use of diagnostic radiology were collected to determine adherence to recommended imaging guidelines.
Of 74 obstetric trauma patients, the most common mechanisms of injury were motor vehicle collisions (81%), assaults (8%), and falls (7%). Despite the mechanism and severity of injury, 29 patients (39%) did not undergo imaging during their initial emergency department assessment. All of the remaining 45 patients (61%) were imaged as part of their assessment; however, plain x-rays were often used to avoid imaging with computed tomography.Of the 32 patients identified with a high-risk mechanism, chest x-ray was used in 84.4%, pelvic x-ray in 28.1%, and computed tomography-angiography in 34.4%. In the high-risk mechanism group, the compliance rate with guidelines was only 18.8% (6 patients had the recommended radiologic assessment).
Concerns about fetal radiation have resulted in a low compliance rate with recommended trauma guidelines at our institution.
Therapeutic/care management study, level IV.
皇家墨尔本医院是一级成人创伤中心，由于与皇家妇女医院相邻，它也是该州主要的产科创伤中心。已制定产科创伤指南以促进对孕妇的管理，但尚未对这些建议的遵守情况进行评估。本研究的目的是评估产科创伤患者对推荐的影像学指南的依从性。
利用皇家墨尔本医院前瞻性整理的创伤登记册，确定2012年1月至12月急诊科收治的产科创伤病例。收集人口统计学资料、损伤机制、临床检查结果以及诊断性放射学的使用情况，以确定对推荐的影像学指南的依从性。
在74例产科创伤患者中，最常见的损伤机制是机动车碰撞（81%）、袭击（8%）和跌倒（7%）。尽管损伤机制和严重程度不同，但29例患者（39%）在首次急诊科评估期间未接受影像学检查。其余45例患者（61%）均接受了影像学检查作为评估的一部分；然而，为避免使用计算机断层扫描成像，常采用普通X线检查。在32例确定为高危机制的患者中，84.4%的患者进行了胸部X线检查，28.1%的患者进行了骨盆X线检查，34.4%的患者进行了计算机断层扫描血管造影检查。在高危机制组中，指南依从率仅为18.8%（6例患者接受了推荐的放射学评估）。
对胎儿辐射的担忧导致我院对推荐的创伤指南的依从率较低。
治疗/护理管理研究，四级。
