Konda Sanjit R, Goch Abraham M, Haglin Jack, Egol Kenneth A
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, New York, NY.
J Orthop Trauma. 2018 May;32(5):216-222. doi: 10.1097/BOT.0000000000001137.
To assess clinical and hospital quality outcomes of patients receiving the previously reported Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury (REDUCTION) imaging protocol.
Retrospective Chart review.
Level I Trauma Center and affiliated Tertiary Care Hospital Center.
PATIENTS/PARTICIPANTS: Fifty patients who received this protocol for acute traumatic fracture evaluation and met the inclusion criteria were compared with a cohort of 50 patients matched for age and fracture type who previously received conventional CT scanning for acute traumatic fracture evaluation.
Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury (REDUCTION) protocol for diagnostic fracture evaluation.
Estimated effective radiation doses were calculated and compared using Digital Imaging and Communications in Medicine (DICOM) information from all included studies. Patient outcomes between groups were compared with time to fracture union as the primary outcome. Secondary outcome measures included the presence of complication defined as infection, malunion, nonunion, failure of nonoperative treatment, painful implants, and implant failure. Other secondary quality outcomes that were recorded included readmission within 30 days and hospital length of stay. Functional quality measures included joint range of motion. Statistical analyses were conducted to identify significant differences between cohorts (significance designated as P < 0.05).
Patient characteristics between cohorts were not significantly different with respect to age, sex, body mass index, comorbidities, injury mechanism, or injury location. Fractures of the elbow, hip, knee, and foot/ankle were evaluated. Mean clinical follow-up was 9.5 ± 4.9 months for the REDUCTION cohort and 12.4 ± 5.3 months for the conventional CT cohort. Mean estimated effective dose for all REDUCTION scans was 0.15 milliSieverts (mSv) as compared to 1.50 mSv for the conventional CT cohort (P = 0.037). Preoperative diagnosis was confirmed intraoperatively in 49/50 cases in the REDUCTION cohort compared with 48/50 cases in the conventional CT cohort (P = 0.79). Outcomes including time to union, range of motion, complications, readmission, treatment failure, reoperation, and length of stay were not significantly different between groups.
The REDUCTION protocol represents ultralow-dose CT developed for minimizing radiation exposure to patients presenting with traumatic fractures. This protocol resulted in a 10-fold reduction in radiation exposure. No difference in clinical or hospital quality outcomes was detected between patients who received this protocol as compared to those receiving automated dose CT. The REDUCTION protocol is a safe and effective method of performing CT for extremity fractures with significantly reduced radiation risk.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估接受先前报道的骨科损伤计算机断层扫描降低有效剂量（REDUCTION）成像方案的患者的临床和医院质量结局。
回顾性病历审查。
一级创伤中心及附属三级医疗中心。
患者/参与者：50例接受该方案进行急性创伤性骨折评估且符合纳入标准的患者与50例年龄和骨折类型匹配、先前接受传统CT扫描进行急性创伤性骨折评估的患者队列进行比较。
采用骨科损伤计算机断层扫描降低有效剂量（REDUCTION）方案进行诊断性骨折评估。
利用所有纳入研究的医学数字成像和通信（DICOM）信息计算并比较估计有效辐射剂量。以骨折愈合时间作为主要结局指标，比较两组患者的结局。次要结局指标包括定义为感染、畸形愈合、不愈合、非手术治疗失败、植入物疼痛和植入物失败的并发症的存在情况。记录的其他次要质量结局包括30天内再入院情况和住院时间。功能质量指标包括关节活动范围。进行统计分析以确定队列之间的显著差异（显著性设定为P<0.05）。
两组患者在年龄、性别、体重指数、合并症、损伤机制或损伤部位方面的特征无显著差异。对肘部、髋部、膝部和足部/踝部骨折进行了评估。REDUCTION队列的平均临床随访时间为9.5±4.9个月，传统CT队列的平均临床随访时间为12.4±5.3个月。所有REDUCTION扫描的平均估计有效剂量为0.15毫西弗（mSv），而传统CT队列的平均估计有效剂量为1.50 mSv（P=0.037）。REDUCTION队列中49/50例患者的术前诊断在术中得到证实，传统CT队列中为48/50例（P=0.79）。两组在包括愈合时间、活动范围、并发症、再入院、治疗失败、再次手术和住院时间等结局方面无显著差异。
REDUCTION方案代表了为尽量减少创伤性骨折患者的辐射暴露而开发的超低剂量CT。该方案使辐射暴露降低了10倍。与接受自动剂量CT的患者相比，接受该方案的患者在临床或医院质量结局方面未检测到差异。REDUCTION方案是一种安全有效的对四肢骨折进行CT检查的方法，辐射风险显著降低。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
