Jost Evan, Roberts Derek J, Penney Todd, Brunet Grant, Ball Chad G, Kirkpatrick Andrew W
Department of Surgery, University of Calgary, Calgary, AB, Canada.
Department of Radiology, University of Calgary, Calgary, AB, Canada.
Am J Surg. 2017 May;213(5):874-880. doi: 10.1016/j.amjsurg.2017.03.016. Epub 2017 Mar 23.
We sought to define the accuracy of findings for detecting hollow viscus injury (HVI) in patients with blunt abdominal trauma (BAT) and unexplained intra-peritoneal free fluid without solid organ injury (UIPFFWSOI).
We screened all consecutive hemodynamically stable patients presenting to a quaternary-care trauma-centre who had an abdominal computed tomography (CT) scan for BAT and UIPFFWSOI (January 2007-December 2014).
Of 3796 patients identified during the study period, 39 presented with UIPFFWSOI. Fifteen underwent therapeutic laparotomy. Seatbelt sign (+LR approaches infinity), diffuse peritonitis (+LR approaches infinity), number of CT cuts with fluid (c-statistic = 0.65), and a lower arterial pH at presentation (c-statistic = 0.62) were most predictive of HVI. Patients operated on within 24 h had shorter stays than those operated on later (median 9 vs. 14 days, p = 0.03).
Our findings suggest that clinical examination and measurements of intraperitoneal fluid volume may help identify HVIs in BAT patients.
我们试图确定在钝性腹部创伤（BAT）且无实体器官损伤的不明原因腹腔内游离液体（UIPFFWSOI）患者中检测中空脏器损伤（HVI）的检查结果准确性。
我们筛查了所有连续入住四级医疗创伤中心、因BAT和UIPFFWSOI接受腹部计算机断层扫描（CT）的血流动力学稳定患者（2007年1月至2014年12月）。
在研究期间确定的3796例患者中，39例出现UIPFFWSOI。15例接受了治疗性剖腹手术。安全带征（阳性似然比接近无穷大）、弥漫性腹膜炎（阳性似然比接近无穷大）、有液体的CT扫描层数（c统计量 = 0.65）以及就诊时较低的动脉血pH值（c统计量 = 0.62）对HVI的预测性最强。在24小时内接受手术的患者住院时间比之后接受手术的患者短（中位数分别为9天和14天，p = 0.03）。
我们的研究结果表明，临床检查和腹腔液体量测量可能有助于识别BAT患者中的HVI。
