From the Division of Trauma and Surgical Critical Care (M.S., K.I., J.M.B., C.P., D.D.), Department of Emergency Medicine (N.O., T.K.), LAC+USC Medical Center, and Keck School of Medicine (J.C.), University of Southern California, Los Angeles, California.
J Trauma Acute Care Surg. 2018 Jul;85(1):113-117. doi: 10.1097/TA.0000000000001868.
Portable chest x-ray (CXR) and extended focused assessment with sonography for trauma (EFAST) screen patients for thoracic injury in the trauma bay. It is unclear if one test alone is sufficient, if both are required, or if the two investigations are complementary. Study objectives were to define the combined diagnostic yield of EFAST and CXR among stable blunt thoracic trauma patients and to determine if a normal EFAST and CXR might obviate the need for computed tomography (CT) scan of the chest.
All blunt trauma patients 15 years or older presenting to LAC+USC Medical Center in 2016 were screened. Only patients who underwent CT thorax were included. Patients were excluded if they presented more than 24 hours after injury, were transferred, or if they did not undergo EFAST and CXR. Demographics, physical examination (PEx) of the thorax, injury data, investigations, procedures, and outcomes were collected. The EFAST, CXR, and PEx findings were compared to the gold standard CT thorax to calculate the diagnostic yield of each investigation and combinations thereof in the assessment for clinically significant thoracic injury.
One thousand three hundred eleven patients met inclusion/exclusion criteria. Most common mechanisms of injury were motor vehicle collision (n = 385, 29%) and auto versus pedestrian trauma (n = 379, 29%). Mean Injury Severity Score was 11 (1-75), with mean Abbreviated Injury Scale chest score of 1.6 (1-6). The sensitivities of EFAST, CXR, and PEx, either individually or in combination, were less than 0.73 in the detection of clinically significant thoracic injury. The most common missed clinically significant injuries were sternal fractures, scapular fractures, clavicular fractures, and pneumothoraces. Motorcycle collisions and auto versus pedestrian traumas resulted in the highest rates of missed injury.
Even in conjunction with the physical examination, the sensitivity of EFAST+CXR in the detection of clinically significant thoracic injury is low. Therefore, if clinical suspicion for injury exists after blunt thoracic trauma, a normal EFAST+CXR is insufficient to exclude injury and CT scan of the chest should be performed.
Diagnostic tests/criteria, level III.
便携式胸部 X 光（CXR）和扩展焦点评估与创伤超声（EFAST）在创伤室筛查患者的胸部损伤。目前尚不清楚单独使用一种检查是否足够，是否需要同时使用两种检查，或者这两种检查是否具有互补性。研究目的是确定稳定的钝性胸部创伤患者中 EFAST 和 CXR 的联合诊断率，并确定正常的 EFAST 和 CXR 是否可以避免胸部 CT 扫描的需要。
2016 年，对洛杉矶加大医疗中心就诊的所有 15 岁及以上的钝性创伤患者进行筛查。仅纳入接受胸部 CT 检查的患者。如果患者在受伤后 24 小时以上就诊、转院或未行 EFAST 和 CXR，则排除在外。收集患者的人口统计学、胸部体格检查（PEx）、损伤数据、检查、操作和结果。将 EFAST、CXR 和 PEx 检查结果与金标准 CT 胸部检查结果进行比较，以计算每种检查方法及其组合在评估临床显著胸部损伤中的诊断率。
符合纳入/排除标准的患者有 1311 名。最常见的损伤机制是机动车碰撞（n = 385，29%）和汽车与行人碰撞（n = 379，29%）。平均损伤严重程度评分（ISS）为 11（1-75），平均胸部简明损伤评分（AIS）为 1.6（1-6）。EFAST、CXR 和 PEx 的单独或组合检测临床显著胸部损伤的敏感性均小于 0.73。最常见的漏诊临床显著损伤是胸骨骨折、肩胛骨骨折、锁骨骨折和气胸。摩托车碰撞和汽车与行人碰撞导致的漏诊率最高。
即使结合体格检查，EFAST+CXR 检测临床显著胸部损伤的敏感性也较低。因此，如果钝性胸部创伤后存在损伤的临床怀疑，正常的 EFAST+CXR 不足以排除损伤，应进行胸部 CT 扫描。
诊断性检查/标准，III 级。
