Camarata Andrew S, Switchenko Jeffrey M, Demidenko Eugene, Flood Ann B, Swartz Harold M, Ali Arif N
*Department of Radiation Oncology, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322; †Winship Cancer Institute, Emory University,1365 Clifton Rd NE, Atlanta, GA 30322; ‡Biostatistics and Bioinformatics, Emory University, 1534 Clifton Rd NE, Atlanta, GA 30322; §EPR Center at Dartmouth, One Medical Center Dr, Lebanon, NH 03766.
Health Phys. 2016 Apr;110(4):391-4. doi: 10.1097/HP.0000000000000476.
Current radiation disaster manuals list the time-to-emesis (TE) as the key triage indicator of radiation dose. The data used to support TE recommendations were derived primarily from nearly instantaneous, high dose-rate exposures as part of variable condition accident databases. To date, there has not been a systematic differentiation between triage dose estimates associated with high and low dose rate (LDR) exposures, even though it is likely that after a nuclear detonation or radiologic disaster, many surviving casualties would have received a significant portion of their total exposure from fallout (LDR exposure) rather than from the initial nuclear detonation or criticality event (high dose rate exposure). This commentary discusses the issues surrounding the use of emesis as a screening diagnostic for radiation dose after LDR exposure. As part of this discussion, previously published clinical data on emesis after LDR total body irradiation (TBI) is statistically re-analyzed as an illustration of the complexity of the issue and confounding factors. This previously published data includes 107 patients who underwent TBI up to 10.5 Gy in a single fraction delivered over several hours at 0.02 to 0.04 Gy min. Estimates based on these data for the sensitivity of emesis as a screening diagnostic for the low dose rate radiation exposure range from 57.1% to 76.6%, and the estimates for specificity range from 87.5% to 99.4%. Though the original data contain multiple confounding factors, the evidence regarding sensitivity suggests that emesis appears to be quite poor as a medical screening diagnostic for LDR exposures.
当前的辐射灾难手册将呕吐时间（TE）列为辐射剂量的关键分诊指标。用于支持TE建议的数据主要来自几乎瞬间的高剂量率照射，这些照射是可变条件事故数据库的一部分。迄今为止，尚未对与高剂量率和低剂量率（LDR）照射相关的分诊剂量估计进行系统区分，尽管在核爆炸或放射灾难后，许多幸存的伤员很可能其总照射量的很大一部分来自沉降物（LDR照射），而非初始核爆炸或临界事件（高剂量率照射）。本评论讨论了将呕吐用作LDR照射后辐射剂量筛查诊断方法所涉及的问题。作为讨论的一部分，对先前发表的关于LDR全身照射（TBI）后呕吐的临床数据进行了统计重新分析，以说明该问题的复杂性和混杂因素。这些先前发表的数据包括107例患者，他们接受了单次剂量高达10.5 Gy的TBI，剂量在数小时内以0.02至0.04 Gy/min的速度给予。基于这些数据，呕吐作为低剂量率辐射照射筛查诊断的敏感性估计范围为57.1%至76.6%，特异性估计范围为87.5%至99.4%。尽管原始数据包含多个混杂因素，但关于敏感性的证据表明，呕吐作为LDR照射的医学筛查诊断方法似乎相当不可靠。
