Murphy Shelby P, Hawthorne Noah, Haase David, Chiku Chika, Wen Jason, Rodriguez Robert M
Department of Emergency Medicine, University of California, San Francisco, San Francisco, California.
J Emerg Med. 2017 Dec;53(6):865-870. doi: 10.1016/j.jemermed.2017.08.036. Epub 2017 Oct 28.
Many trauma centers have adopted routine head-to-pelvis computed tomography (CT) imaging for the evaluation of adults with blunt trauma.
We sought to determine the yields of detecting clinically significant injuries (CSIs) with CT in >1 anatomic region.
We conducted this observational cohort study of all trauma activation patients >14 years of age who received CT imaging during blunt trauma evaluation at a Level 1 trauma center from April to October 2014. Expert panels determined the clinical significance of head, neck, chest, abdomen, and pelvis injuries seen on CT. We calculated yields of CSI, defined as the number of patients with CSI divided by the total number of patients who underwent CT imaging. The 3 specified anatomic regions considered were head/neck, chest, and abdomen/pelvis.
The median age of 1236 patients who had CT was 48 years; 69% were male; 51.2% were admitted; and hospital mortality was 4.4%. Yields of CSI with 95% confidence intervals (CIs) were: head/neck region injury 11.3% (9.6-13.3%); chest region injury only 7.9% (6.0-10.4%); abdomen/pelvis region injury only 5.1% (3.7-7.0%); both head/neck and chest CSI 2.8% (1.7-4.5%); both head/neck and abdomen/pelvis CSI 1.6% (0.9-2.9%); and both chest and abdomen/pelvis CSI 1.1% (0.5-2.4%). The yield of CSI in all 3 anatomic regions with head-to-pelvis CT was 0.6% (0.2-1.7%), and 76.7% (68.8-83.1%) of CSIs occurred in isolation.
During multiple anatomic region CT imagng for adult blunt trauma evaluation, the yield for CSI in >1 region is low. In low-risk populations, selective CT imaging of anatomic regions (instead of reflexive head-to-pelvis CT imaging) may be more appropriate.
许多创伤中心已采用常规的从头至骨盆的计算机断层扫描（CT）成像来评估钝性创伤的成人患者。
我们试图确定CT在一个以上解剖区域检测具有临床意义损伤（CSI）的检出率。
我们对2014年4月至10月在一级创伤中心接受钝性创伤评估期间接受CT成像的所有14岁以上创伤激活患者进行了这项观察性队列研究。专家小组确定了CT上所见头部、颈部、胸部、腹部和骨盆损伤的临床意义。我们计算了CSI的检出率，定义为患有CSI的患者数量除以接受CT成像的患者总数。所考虑的3个指定解剖区域为头/颈、胸部和腹部/骨盆。
1236例接受CT检查患者的中位年龄为48岁；69%为男性；51.2%入院；医院死亡率为4.4%。CSI的检出率及其95%置信区间（CI）为：头/颈区域损伤11.3%（9.6 - 13.3%）；仅胸部区域损伤7.9%（6.0 - 10.4%）；仅腹部/骨盆区域损伤5.1%（3.7 - 7.0%）；头/颈和胸部均有CSI 2.8%（1.7 - 4.5%）；头/颈和腹部/骨盆均有CSI 1.6%（0.9 - 2.9%）；胸部和腹部/骨盆均有CSI 1.1%（0.5 - 2.4%）。从头至骨盆CT在所有3个解剖区域的CSI检出率为0.6%（0.2 - 1.7%），76.7%（68.8 - 83.1%）的CSI单独出现。
在对成人钝性创伤评估进行多解剖区域CT成像时，一个以上区域的CSI检出率较低。在低风险人群中，对解剖区域进行选择性CT成像（而不是反射性的从头至骨盆CT成像）可能更合适。
