创伤患者CT扫描的偶然发现：是否会影响住院时间？
CT scan incidental findings in trauma patients: does it impact hospital length of stay?
作者信息
Andrawes Peter, Picon Antonio I, Shariff Masood A, Azab Basem, von Waagner Wolf, Demissie Seleshi, Fasanya Charles
机构信息
Department of Surgery, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, New York, USA.
Department of Surgery-Surgical Oncology, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, New York, USA.
出版信息
Trauma Surg Acute Care Open. 2017 Sep 14;2(1):e000101. doi: 10.1136/tsaco-2017-000101. eCollection 2017.
BACKGROUND
CT scans are heavily relied on for assessment of solid organ injuries complementing clinical examination. These CT scans could also reveal pathologies not related to trauma called incidental findings. We aimed to evaluate the frequency of these findings and their outcome on hospital services.
METHODS
A retrospective chart review of prospectively collected data of the emergency department's trauma database from January 2005 to December 2011 to evaluate incidental findings on CT scans on trauma admissions. These incidental findings were divided into three classes: class 1-minor degenerative, non-degenerative, normal variants or congenital finding that does not require further investigation or workup; class 2-findings not requiring urgent intervention with scheduled outpatient follow-up and class 3-all findings that require urgent evaluation/further investigation during the same hospital admission. One-year follow-up was done to review hospital length of stay, trauma clinic follow-up and post-trauma surgery.
RESULTS
Of 1000 charts reviewed, 957 were selected after 43 patients were excluded due to incomplete documentation. Of the 957 patients, 385 (40%) were found to have incidental findings. A total of 560 incidental findings were found on the CT scan reports with one-third of patients having multiple findings (144 patients, 37.4%). The largest number of incidental findings were in class 2. The incidental group had significantly longer length of stay after adjusted multivariate analysis (8.7±0.48 vs 6.7±0.55, p=0.005).
CONCLUSION
The incidental findings are commonly found during CT imaging in trauma centers and our rate was 40%. Appropriate documentation, communication and follow-up of those findings is necessary. A classification system for these findings practiced nationwide will aid in categorizing the urgency of continued follow-up. This also will help decrease the length of hospital stay and healthcare cost.
LEVEL OF EVIDENCE
Level 4.
背景
CT扫描在评估实体器官损伤方面严重依赖于辅助临床检查。这些CT扫描还可能揭示与创伤无关的病变，即偶然发现。我们旨在评估这些发现的频率及其对医院服务的影响。
方法
对2005年1月至2011年12月急诊科创伤数据库中前瞻性收集的数据进行回顾性图表审查，以评估创伤入院患者CT扫描中的偶然发现。这些偶然发现分为三类：1类——轻微退行性、非退行性、正常变异或先天性发现，无需进一步检查或处理；2类——无需紧急干预，安排门诊随访的发现；3类——所有需要在同一住院期间进行紧急评估/进一步检查的发现。进行一年的随访，以审查住院时间、创伤门诊随访和创伤后手术情况。
结果
在审查的1000份图表中，43例因记录不完整被排除后，共入选957例。在这957例患者中，385例（40%）被发现有偶然发现。CT扫描报告中共发现560项偶然发现，三分之一的患者有多项发现（144例，37.4%）。偶然发现数量最多的是2类。经调整的多变量分析后，偶然发现组的住院时间明显更长（8.7±0.48天对6.7±0.55天，p=0.005）。
结论
偶然发现在创伤中心的CT成像中很常见，我们的发生率为40%。对这些发现进行适当的记录、沟通和随访是必要的。全国范围内实施的这些发现的分类系统将有助于对持续随访的紧迫性进行分类。这也将有助于缩短住院时间和降低医疗成本。
证据水平
4级。
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