Department of Surgery, Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Department of Surgery, Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Am J Emerg Med. 2021 Jan;39:121-124. doi: 10.1016/j.ajem.2020.01.037. Epub 2020 Jan 20.
Early diagnosis of blunt cerebrovascular injury (BCVI) is among the most difficult challenges in trauma treatment. This study aimed to determine the optimal timing of computed tomographic angiography (CTA) screening for suspicious BCVI in patients with polytrauma.
We reviewed the trauma registry and medical records of patients with head and neck injuries from a Level I trauma center between January 2012 and December 2016. Those receiving CTA within 24 h of presentation at the emergency department were the primary CTA group; those who received CTA after 24 h were the delayed CTA group. The basic demographics, indications for CTA, CTA severity grading, and outcomes were compared.
In all, 228 patients received brain CTA. Most were male (75%); the mean age was around 40 years. The 38 patients with positive BCVI had a significantly higher ratio of severe chest trauma (52.6% vs 25.8%, p = 0.001); 26 of them received primary CTA and 12 received delayed CTA. Patients with polytrauma predominated in the delayed CTA group (66.7% vs 30.8%, p = 0.037). Of the patients in the primary CTA group, 26.9% received CTA due to symptomatic presentation (p = 0.047). Patients in the delayed group had better neurological outcomes (83% neurologically intact, vs 38.5%, p = 0.01) and lower mortality (0% vs 26.9%, p = 0.047). The only independent positive prognostic factor was initial motor response ≥M5 (Odds Ratio 21.46, 95% Confidence Interval 2.01-228.71).
For patients with polytrauma, performing brain CTA for BCVI screening in the first 24-h or after may not affect clinical outcome. Initial motor response is the sole indicator for outcome. Delaying the study for to the next 24-hour can be considered in such patients, when regarding hemodynamic stability, the dose of contrast medium, and the radiation exposure.
钝性脑血管损伤 (BCVI) 的早期诊断是创伤治疗中最具挑战性的难题之一。本研究旨在确定多发伤患者中疑似 BCVI 的 CT 血管造影 (CTA) 筛查的最佳时间。
我们回顾了 2012 年 1 月至 2016 年 12 月期间，一家一级创伤中心的头部和颈部损伤患者的创伤登记处和病历。在急诊科就诊后 24 小时内接受 CTA 的患者为主要 CTA 组；在 24 小时后接受 CTA 的患者为延迟 CTA 组。比较了两组的基本人口统计学资料、CTA 指征、CTA 严重程度分级和结局。
共有 228 例患者接受了脑部 CTA。大多数为男性（75%）；平均年龄约为 40 岁。38 例阳性 BCVI 患者中，严重胸部创伤的比例明显较高（52.6%比 25.8%，p=0.001）；其中 26 例行主要 CTA，12 例行延迟 CTA。多发伤患者在延迟 CTA 组中占主导地位（66.7%比 30.8%，p=0.037）。在主要 CTA 组中，26.9%的患者因症状表现而接受 CTA（p=0.047）。延迟组的神经结局更好（83%神经功能完整，38.5%，p=0.01），死亡率更低（0%比 26.9%，p=0.047）。唯一的独立阳性预后因素是初始运动反应≥M5（优势比 21.46，95%置信区间 2.01-228.71）。
对于多发伤患者，在最初 24 小时内或之后进行脑 CTA 筛查可能不会影响临床结局。初始运动反应是唯一的预后指标。在考虑血流动力学稳定、造影剂剂量和辐射暴露时，可以考虑在这些患者中延迟至下一个 24 小时进行检查。
