Ellison Angela M, Quayle Kimberly S, Bonsu Bema, Garcia Madelyn, Blumberg Stephen, Rogers Alexander, Wootton-Gorges Sandra L, Kerrey Benjamin T, Cook Lawrence J, Cooper Arthur, Kuppermann Nathan, Holmes James F
Department of Pediatrics, Perelman School of Medicine/Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Pediatrics, Washington University/St. Louis Children's Hospital, St. Louis, MO.
Ann Emerg Med. 2015 Aug;66(2):107-114.e4. doi: 10.1016/j.annemergmed.2015.01.014. Epub 2015 Mar 17.
We compare test characteristics of abdominal computed tomography (CT) with and without oral contrast for identifying intra-abdominal injuries.
This was a planned subanalysis of a prospective, multicenter study of children (<18 years) with blunt torso trauma. Children imaged in the emergency department with abdominal CT using intravenous contrast were eligible. Oral contrast use was based on the participating centers' guidelines and discretions. Clinical courses were followed to identify patients with intra-abdominal injuries. Abdominal CTs were considered positive for intra-abdominal injury if a specific intra-abdominal injury was identified and considered abnormal if any findings suggestive of intra-abdominal injury were identified on the CT.
A total of 12,044 patients were enrolled, with 5,276 undergoing abdominal CT with intravenous contrast. Of the 4,987 CTs (95%) with documented use or nonuse of oral contrast, 1,010 (20%) were with and 3,977 (80%) were without oral contrast; 686 patients (14%) had intra-abdominal injuries, including 127 CTs (19%) with and 559 (81%) without oral contrast. The sensitivity in the detection of any intra-abdominal injury in the oral contrast versus no oral contrast groups was sensitivitycontrast 99.2% (95% confidence interval [CI] 95.7% to 100.0%) versus sensitivityno contrast 97.7% (95% CI 96.1% to 98.8%), difference 1.5% (95% CI -0.4% to 3.5%). The specificity of the oral contrast versus no oral contrast groups was specificitycontrast 84.7% (95% CI 82.2% to 87.0%) versus specificityno contrast 80.8% (95% CI 79.4% to 82.1%), difference 4.0% (95% CI 1.3% to 6.7%).
Oral contrast is still used in a substantial portion of children undergoing abdominal CT after blunt torso trauma. With the exception of a slightly better specificity, test characteristics for detecting intra-abdominal injury were similar between CT with and without oral contrast.
我们比较了使用和不使用口服对比剂的腹部计算机断层扫描（CT）在识别腹腔内损伤方面的检测特征。
这是一项对前瞻性、多中心研究中遭受钝性躯干创伤的儿童（<18岁）进行的计划亚分析。在急诊科使用静脉造影剂进行腹部CT检查的儿童符合条件。口服对比剂的使用基于参与中心的指南和判断。跟踪临床病程以识别腹腔内损伤患者。如果识别出特定的腹腔内损伤，则腹部CT被认为腹腔内损伤呈阳性；如果在CT上发现任何提示腹腔内损伤的迹象，则被认为异常。
共纳入12044例患者，其中5276例接受了静脉造影剂腹部CT检查。在有口服对比剂使用记录或未使用记录的4987例CT检查中（95%），1010例（20%）使用了口服对比剂，3977例（80%）未使用口服对比剂；686例患者（14%）有腹腔内损伤，其中127例CT检查（19%）使用了口服对比剂，559例（81%）未使用口服对比剂。口服对比剂组与未使用口服对比剂组在检测任何腹腔内损伤方面的敏感性分别为：使用对比剂组敏感性为99.2%（95%置信区间[CI]95.7%至100.0%），未使用对比剂组敏感性为97.7%（95%CI 96.1%至98.8%），差异为1.5%（95%CI -0.4%至3.5%）。口服对比剂组与未使用口服对比剂组的特异性分别为：使用对比剂组特异性为84.7%（95%CI 82.2%至87.0%），未使用对比剂组特异性为80.8%（95%CI 79.4%至82.1%），差异为4.0%（95%CI 1.3%至6.7%）。
在遭受钝性躯干创伤后接受腹部CT检查的儿童中，仍有相当一部分使用口服对比剂。除特异性稍高外，使用和不使用口服对比剂的CT在检测腹腔内损伤方面的检测特征相似。
