Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Injury. 2019 Sep;50(9):1511-1515. doi: 10.1016/j.injury.2019.07.036. Epub 2019 Jul 30.
Increasing global demand for specialized radiological investigations has resulted in delayed or non-reporting of plain trauma radiographs by radiologists. This is particularly true in resource-limited environments, where referring clinicians rely largely on their own radiographic interpretation. A wide accuracy range has been documented for non-radiologist reporting of conventional trauma radiographs. The Lodox Statscan whole-body digital X-ray machine is a relatively new technology that poses unique interpretive challenges. The fracture detection rate of trauma clinicians utilizing this modality has not been determined.
An audit of the polytrauma fracture detection rate of clinicians evaluating Lodox Statscan bodygrams in two South African public-sector Trauma Units.
A retrospective descriptive study of imaging data of Cape Town Level 1-equivalent public-sector Trauma Units during March-April 2015. Statscan bodygrams acquired for adult polytrauma triage were reviewed and correlated with follow-up imaging and patient records. Missed fractures were stratified by body part, mechanism of injury and ventilatory support. The fracture detection rate was determined with 95% confidence. The Generalised Fischer Exact Test assessed any association between the fracture site and failure of detection. Specialist orthopaedic review assessed the potential need for surgical management of missed fractures.
227 patients (male = 193, 85%; mean age: 33 years) were included; 195 fractures were demonstrated on the whole-body triage projections. Lower limb fractures predominated (n = 66, 34%). The fracture detection rate was 89% (95% CI = 86-93%), with the site of fracture associated with failure of detection (p = 0.01). Twelve of 21 undetected fractures (57%) involved the elbow or shoulder girdle. All elbow fractures (n = 3, 100%), more than half the shoulder girdle fractures (9/13,69%) and 12% (15/123) of extremity fractures were undetected. One missed fracture (1/21,4.7%) unequivocally required surgical management, while a further 7 (7/21, 33.3%) could potentially have benefitted from surgery, depending on follow-up imaging findings.
This is the first analysis of the accuracy of bodygram polytrauma fracture detection by clinicians. Particular review of the shoulder girdle, elbow and extremities for subtle fractures, in addition to standardized limb positioning, are recommended for improved diagnostic accuracy in this setting. These findings can inform clinician training courses in this domain.
全球对专业放射学检查的需求不断增加，导致放射科医生延迟或未能报告普通创伤 X 光片。在资源有限的环境中，这种情况尤其如此，因为转诊临床医生主要依赖自己的放射学解读。非放射科医生对常规创伤 X 光片的报告准确性范围很广。Lodox Statscan 全身数字 X 射线机是一种相对较新的技术，它带来了独特的解释挑战。利用这种方式评估创伤患者的骨折检出率尚未确定。
对两家南非公立部门创伤单位使用 Lodox Statscan 全身数字 X 射线机评估的多部位创伤骨折检出率进行审核。
对 2015 年 3 月至 4 月期间开普敦一级等效公立部门创伤单位的成像数据进行回顾性描述性研究。对用于成人多发创伤分诊的 Statscan 全身数字 X 射线机采集的图像进行了审查，并与后续影像学检查和患者记录进行了相关性分析。根据身体部位、损伤机制和通气支持情况对漏诊骨折进行分层。用 95%置信区间确定骨折检出率。广义 Fischer 精确检验评估骨折部位与漏诊之间是否存在关联。专门的骨科审查评估了漏诊骨折是否需要手术治疗。
共纳入 227 例患者（男性 193 例，占 85%；平均年龄 33 岁）；在全身筛查投影上共显示 195 处骨折。下肢骨折占主导地位（n=66，34%）。骨折检出率为 89%（95%CI=86-93%），骨折部位与漏诊相关（p=0.01）。21 处未检出骨折中有 12 处（57%）位于肘部或肩部。所有肘部骨折（n=3，100%）、超过一半的肩部骨折（9/13，69%）和 12%（15/123）的四肢骨折均未检出。1 处漏诊骨折（1/21，4.7%）明确需要手术治疗，而另外 7 处（7/21，33.3%）可能需要手术治疗，具体取决于后续影像学检查结果。
这是首次分析临床医生对全身数字 X 射线机多部位创伤骨折的检出准确性。建议在此情况下，特别对肩部、肘部和四肢进行细微骨折的审查，并对肢体进行标准化定位，以提高诊断准确性。这些发现可以为该领域的临床医生培训课程提供信息。
