血浆D-二聚体可安全减少在评估小儿头部创伤时进行的不必要的CT扫描。
Plasma D-dimer safely reduces unnecessary CT scans obtained in the evaluation of pediatric head trauma.
作者信息
Langness Simone, Ward Erin, Halbach Jonathan, Lizardo Radhames, Davenport Katherine, Bickler Stephen, Kling Karen, Thangarajah Hari, Grabowski Julia, Fairbanks Timothy
机构信息
University of California, 200 W. Arbor Dr, #8220, San Diego, CA 92101, United States; Rady Children's Hospital, 3030 Children's Way, Suite 107, San Diego, CA 92123, United States.
Rady Children's Hospital, 3030 Children's Way, Suite 107, San Diego, CA 92123, United States; Naval Medical Center, 34800 Bob Wilson Dr., San Diego, CA 92134, United States.
出版信息
J Pediatr Surg. 2018 Apr;53(4):752-757. doi: 10.1016/j.jpedsurg.2017.08.017. Epub 2017 Sep 1.
PURPOSE
Serum D-dimer has been proposed as a biomarker to aid in the diagnosis of pediatric traumatic brain injury (TBI). We investigated the accuracy of D-dimer in predicting the absence of TBI and evaluated the degree by which D-dimer could limit unnecessary computed tomography scans of the head (CTH).
METHODS
Retrospective review of patients with suspected TBI from 2011 to 2013 who underwent evaluation with CTH and quantitative D-dimer. D-dimer levels were compared among patients with clinically-important TBI (ciTBI), TBI, isolated skull fracture and no injury.
RESULTS
Of the 663 patients evaluated for suspected TBI, ciTBI was identified in 116 (17.5%), TBI in 77 (11.6%), skull fracture in 61 (9.2%) and no head injury in 409 (61.7%). Patients with no head injury had significantly lower D-dimer values (1531±1791pg/μL) compared to those with skull fracture, TBI and ciTBI (2504±1769, 2870±1633 and 4059±1287pg/μL, respectively, p<0.005). Using a D-dimer value <750pg/μL as a negative screen, no ciTBIs would be missed and 209 CTHs avoided (39.7% of total).
CONCLUSION
Low plasma D-dimer predicts the absence of ciTBI for pediatric patient with suspected TBI. Incorporating D-dimer into current diagnostic algorithms may significantly limit the number of unnecessary CTHs performed in this population.
TYPE OF STUDY
Study of diagnostic test.
LEVEL OF EVIDENCE
I.
目的
血清D-二聚体已被提议作为一种生物标志物，以辅助小儿创伤性脑损伤（TBI）的诊断。我们研究了D-二聚体在预测无TBI方面的准确性，并评估了D-二聚体能够减少不必要的头部计算机断层扫描（CTH）的程度。
方法
回顾性分析2011年至2013年疑似TBI且接受了CTH评估和D-二聚体定量检测的患者。比较了具有临床重要性的TBI（ciTBI）、TBI、单纯颅骨骨折和无损伤患者的D-二聚体水平。
结果
在663例接受疑似TBI评估的患者中，确诊ciTBI的有116例（17.5%），TBI的有77例（11.6%），颅骨骨折的有61例（9.2%），无头部损伤的有409例（61.百分之七）。与颅骨骨折、TBI和ciTBI患者相比，无头部损伤患者的D-二聚体值显著更低（分别为1531±1791pg/μL、2504±1769、2870±1633和4059±1287pg/μL，p<0.005）。以D-二聚体值<750pg/μL作为阴性筛查标准，不会漏诊任何ciTBI病例，可避免209次CTH检查（占总数的39.7%）。
结论
低血浆D-二聚体可预测疑似TBI的小儿患者无ciTBI。将D-二聚体纳入当前诊断算法可能会显著减少该人群中不必要的CTH检查次数。
研究类型
诊断试验研究。
证据水平
I级。
Zotero 插件