Morales-Uribe Carlos, Ramírez Ana, Suarez-Poveda Tatiana, Ortiz Margarita, Sanabria Alvaro
Department of Surgery, School of Medicine, Universidad de Antioquia, Hospital San Vicente de Paul, Calle 64 # 51 D - 154, Medellín, Colombia.
Department of Radiology, School of Medicine, Universidad de Antioquia, Hospital San Vicente de Paul, Medellín, Colombia.
Emerg Radiol. 2016 Oct;23(5):421-31. doi: 10.1007/s10140-016-1412-3. Epub 2016 Jun 1.
This study was conducted in order to define the diagnostic performance of CT angiography for vascular injuries compared with angiography in patients with neck trauma. CT angiography is the cornerstone of diagnosis for hemodynamically stable patients with wounds suspicious of vascular trauma in the limbs, chest, or abdomen. Available evidence for the use of CT angiography in neck vascular trauma comes from small case series and few randomized controlled trials, and high-quality information does not exist regarding its performance. A protocol using the recommendations of the Cochrane Collaboration was designed. A systematic search of diagnostic studies without limits on language or time was carried out to December 2014. Studies including patients with neck trauma with retrospective or prospective data collection that assessed CT angiography compared with other methods were selected. Methodological quality was assessed using the QUADAS-2 tool. A hierarchical model ROC curve and a bivariate random effects model were used for the pooled analysis. Sixteen studies were selected and reviewed, and nine studies with 693 patients were included in this review. The overall sensitivity was 97 % (95 % CI 0.77-1.00; I (2) = 65.7 % (41.4-90.0)), while the overall specificity was 99 % (95 % CI 0.93-1.00; I (2) = 0). The hierarchic ROC curve showed an area under the curve of 0.99. Publication bias was not identified in this study. CT angiography can be stated as the gold standard for diagnosing vascular injuries in hemodynamically stable patients with neck trauma.
本研究旨在确定与血管造影相比，CT血管造影对颈部创伤患者血管损伤的诊断性能。CT血管造影是诊断四肢、胸部或腹部有血管创伤可疑伤口且血流动力学稳定患者的基石。关于CT血管造影在颈部血管创伤中应用的现有证据来自小样本病例系列和少数随机对照试验，且尚无关于其性能的高质量信息。设计了一项采用Cochrane协作组建议的方案。对截至2014年12月的诊断性研究进行了不限语言和时间的系统检索。选择了包括颈部创伤患者且采用回顾性或前瞻性数据收集方法评估CT血管造影并与其他方法进行比较的研究。使用QUADAS-2工具评估方法学质量。采用分层模型ROC曲线和双变量随机效应模型进行汇总分析。筛选并回顾了16项研究，本综述纳入了9项涉及693例患者的研究。总体敏感性为97%（95%CI 0.77-1.00；I² = 65.7%（41.4-90.0）），而总体特异性为99%（95%CI 0.93-1.00；I² = 0）。分层ROC曲线显示曲线下面积为0.99。本研究未发现发表偏倚。对于血流动力学稳定的颈部创伤患者，CT血管造影可被视为诊断血管损伤的金标准。
