钝性腹部创伤患者中超声、体格检查与计算机断层扫描的比较。

Hekimoğlu Azad, Ergun Onur, Özkan Seda, Arslan Engin Deniz, Hekimoğlu Baki

Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey.

Department of Emergency Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey.

Ulus Travma Acil Cerrahi Derg. 2019 Jul;25(4):369-377. doi: 10.5505/tjtes.2018.88288.

BACKGROUND

In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations.

METHODS

In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods.

RESULTS

The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001).

CONCLUSION

Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.

背景

在钝性腹部创伤病例中，腹部是第三大受影响区域。计算机断层扫描（CT）是评估这些患者的金标准。然而，考虑到其损害作用和高成本，将每个到急诊科就诊的患者都送去做CT检查可能不合适。在本研究中，我们的目的是比较超声检查（US）和体格检查在钝性腹部创伤患者中的准确性与金标准CT，以避免不必要的CT检查。

方法

在这项回顾性研究中，筛选了我院急诊科2248例患者的病历和图像。共有535例成年患者在超声检查和体格检查后接受了CT扫描并纳入研究。将超声检查和体格检查的结果、腹腔内游离液体及器官裂伤情况与CT结果进行比较。用统计学方法分析所获数据的一致性、敏感性、特异性、阳性预测值和阴性预测值。

结果

在钝性腹部创伤患者中，超声检查显示腹腔内游离液体的敏感性与CT相当（p = 0.302）。超声检查在确定腹腔内器官损伤时的敏感性和特异性分别为49.6%和99.3%。与CT相比，体格检查在确定游离液体和器官损伤时的敏感性和特异性分别为59%和87%。尽管根据统计计算，体格检查在器官损伤方面的敏感性和特异性分别较高，但似乎没有统计学上的显著预测价值（p < 0.001）。