McNutt Michelle K, Chinapuvvula Naga R, Beckmann Nicholas M, Camp Elizabeth A, Pommerening Matthew J, Laney Rece W, West O Clark, Gill Brijesh S, Kozar Rosemary A, Cotton Bryan A, Wade Charles E, Adams Phillip R, Holcomb John B
From the University of Texas Health Science Center at Houston, Department of Surgery, Division of Acute Care Surgery, Houston, Texas.
J Trauma Acute Care Surg. 2015 Jan;78(1):105-11. doi: 10.1097/TA.0000000000000471.
Computed tomography (CT) scan of the abdomen has been used for 30 years to evaluate the stable blunt trauma patient. However, the early diagnosis of blunt hollow viscus injury (BHVI) remains a challenge. Delayed diagnosis and intervention of BHVI lead to significant morbidity and mortality. This study aimed to identify a combination of radiographic and clinical variables present at admission that could lead to earlier surgical intervention for BHVI.
Significant predictors were identified through a retrospective review of all blunt trauma patients admitted to a Level 1 trauma center from 2005 to 2010 with an admission CT of the abdomen/pelvis and diagnosed with any mesenteric injury. The Bowel Injury Prediction Score (BIPS) was calculated based on the following three elements with a point given for each outcome: white blood cell count of 17.0 or greater, abdominal tenderness, and CT scan grade for mesenteric injury of 4 or higher.
A total of 18,927 blunt trauma patients were admitted during the study period. Of these, 380 had a mesenteric injury, 110 met inclusion criteria, 60 had a surgical intervention, and 43 had BHVI. Of the 110 study patients, 43 (39%) had an immediate operation, 17 (16%) had a delayed operation (>4 hours), and 50 (46%) had no surgical intervention. The median BIPS for the immediate and delayed group was 2, while for the no-surgery group, the score was 0. Patients with a BIPS of 2 or greater were 19 times more likely to have a BHVI than patients with a BIPS of less than 2 (odds ratio, 19.2; 95% confidence interval, 6.78-54.36; p < 0.001).
Three predictors (admission CT scan grade of mesenteric injury, white blood cell count, and abdominal tenderness) were used to create a new bowel injury score, with a score of 2 or greater being strongly associated with BHVI. Prospective validation of these retrospective findings is warranted to fully assess the accuracy of the BIPS.
Prognostic study, level III.
腹部计算机断层扫描（CT）已用于评估稳定的钝性创伤患者30年。然而，钝性中空脏器损伤（BHVI）的早期诊断仍然是一项挑战。BHVI的延迟诊断和干预会导致显著的发病率和死亡率。本研究旨在确定入院时存在的影像学和临床变量的组合，这些组合可能导致对BHVI进行更早的手术干预。
通过回顾性分析2005年至2010年入住一级创伤中心、入院时进行了腹部/骨盆CT检查且被诊断为任何肠系膜损伤的所有钝性创伤患者，确定显著的预测因素。肠道损伤预测评分（BIPS）基于以下三个因素计算，每个结果计1分：白细胞计数为17.0或更高、腹部压痛、肠系膜损伤的CT扫描分级为4级或更高。
研究期间共收治18927例钝性创伤患者。其中，380例有肠系膜损伤，110例符合纳入标准，60例接受了手术干预，43例有BHVI。在110例研究患者中，43例（39%）立即进行了手术，17例（16%）延迟手术（>4小时），50例（46%）未进行手术干预。立即手术组和延迟手术组的BIPS中位数为2，而未手术组的评分为0。BIPS为2或更高的患者发生BHVI的可能性是BIPS小于2的患者的19倍（比值比，19.2；95%置信区间，6.78 - 54.36；p < 0.001）。
使用三个预测因素（入院时肠系膜损伤的CT扫描分级、白细胞计数和腹部压痛）创建了一个新的肠道损伤评分，评分2或更高与BHVI密切相关。有必要对这些回顾性研究结果进行前瞻性验证，以全面评估BIPS的准确性。
预后研究，III级。
