Moussavi Nushin, Davoodabadi Abdol Hossein, Atoof Fatemeh, Razi Seyed Ebrahim, Behnampour Mehdi, Talari Hamid Reza
Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran.
Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, IR Iran.
Arch Trauma Res. 2015 Jun 20;4(2):e25299. doi: 10.5812/atr.25299v2. eCollection 2015 Jun.
Computerized Tomography (CT) scan is gaining more importance in the initial evaluation of patients with multiple trauma, but its effect on the outcome is still unclear. Until now, no prospective randomized trial has been performed to define the role of routine chest CT in patients with blunt trauma.
In view of the considerable radiation exposure and the high costs of CT scan, the aim of this study was to assess the effects of performing the routine chest CT on the outcome as well as complications in patients with blunt trauma.
After approval by the ethics board committee, 100 hemodynamically stable patients with high-energy blunt trauma were randomly divided into two groups. For group one (control group), only chest X-ray was requested and further diagnostic work-up was performed by the decision of the trauma team. For group two, a chest X-ray was ordered followed by a chest CT, even if the chest X-ray was normal. Injury severity, total hospitalization time, Intensive Care Unit (ICU) admission time, duration of mechanical ventilation and complications were recorded. Data were evaluated using t-test, Man-Whitney and chi-squared test.
No significant differences were found regarding the demographic data such as age, injury severity and Glasgow Coma Scale (GCS). Thirty-eight percent additional findings were seen in chest CT in 26% of the patients of the group undergoing routine chest CT, leading to 8% change in management. The mean of in-hospital stay showed no significant difference in both groups with a P value of 0.098. In addition, the mean ICU stay and ventilation time revealed no significant differences (P values = 0.102 and 0.576, respectively). Mortality rate and complications were similar in both groups.
Performing the routine chest CT in high-energy blunt trauma patients (with a mean injury severity of 9), although leading to the diagnosis of some occult injuries, has no impact on the outcome and does not decrease the in-hospital stay and ICU admission time. It seems that performing the routine chest CT in these patients may lead to overtreatment of nonsignificant injuries. The decision about performing routine CT scan in a trauma center should be made cautiously, considering the detriments and benefits.
计算机断层扫描（CT）在多发伤患者的初始评估中变得越来越重要，但其对预后的影响仍不明确。到目前为止，尚未进行前瞻性随机试验来确定常规胸部CT在钝性创伤患者中的作用。
鉴于CT扫描有相当大的辐射暴露且成本高昂，本研究的目的是评估常规胸部CT对钝性创伤患者的预后及并发症的影响。
经伦理委员会批准，将100例血流动力学稳定的高能钝性创伤患者随机分为两组。对于第一组（对照组），仅要求进行胸部X线检查，进一步的诊断检查由创伤团队决定。对于第二组，即使胸部X线检查正常，也先进行胸部X线检查，然后进行胸部CT检查。记录损伤严重程度、总住院时间、重症监护病房（ICU）入院时间、机械通气时间和并发症情况。数据采用t检验、曼-惠特尼检验和卡方检验进行评估。
在年龄、损伤严重程度和格拉斯哥昏迷量表（GCS）等人口统计学数据方面未发现显著差异。在接受常规胸部CT检查的组中，26%的患者胸部CT发现了38%的额外病变，导致治疗方案改变8%。两组的平均住院时间无显著差异，P值为0.098。此外，平均ICU住院时间和通气时间也无显著差异（P值分别为0.102和0.576）。两组的死亡率和并发症相似。
对高能钝性创伤患者（平均损伤严重程度为9）进行常规胸部CT检查虽然能诊断出一些隐匿性损伤，但对预后没有影响，也不会缩短住院时间和ICU入院时间。在这些患者中进行常规胸部CT检查似乎可能导致对无显著意义的损伤进行过度治疗。考虑到利弊，创伤中心关于进行常规CT扫描的决定应谨慎做出。
