Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida.
Department of Otolaryngology, New York University School of Medicine, New York, New York.
Laryngoscope. 2021 Jan;131(1):E278-E282. doi: 10.1002/lary.28565. Epub 2020 Feb 25.
OBJECTIVES/HYPOTHESIS: To identify which patients with temporal bone fractures who have already undergone trauma pan-scan computed tomography (CT) do not require an additional dedicated temporal bone CT. To determine the added cost of dedicated temporal bone CT in a lower-risk group of patients.
Retrospective chart review.
A chart review was conducted of adult patients at a large level I trauma center with temporal bone fractures who underwent both trauma pan-scan CT and dedicated temporal bone CT. Patients were risk stratified into lower- and higher-risk groups based on imaging and physical exam findings. Imaging findings regarding five critical anatomic structures were compared between the two types of CT scans.
There were 180 patients who met inclusion criteria, with 120 patients stratified to the lower-risk group. The negative predictive values of trauma pan-scan CT within the lower-risk group for fracture involvement with the five critical anatomic structures were as follows: otic capsule (1.000), carotid canal (0.960), facial nerve canal (1.000), ossicular chain (0.992), and tegmen (0.856). The annual out-of-pocket cost to patients for dedicated temporal bone CT imaging in the lower-risk group was estimated to be approximately $34,000, for a total of $190,000 during the complete study period.
Trauma pan-scan CT may be sufficient in lower-risk patients to identify temporal bone fracture involvement with critical anatomic structures of the temporal bone. Reductions in dedicated temporal bone imaging will decrease both radiation exposure to trauma patients and strain on radiology departments.
4 Laryngoscope, 131:E278-E282, 2021.
目的/假设：确定已经接受过创伤全扫描计算机断层扫描（CT）的颞骨骨折患者中，哪些患者不需要额外进行专门的颞骨 CT。确定在风险较低的患者组中进行专门的颞骨 CT 的附加成本。
回顾性图表审查。
对一家大型一级创伤中心的颞骨骨折成年患者进行了图表审查，这些患者均接受了创伤全扫描 CT 和专门的颞骨 CT。根据影像学和体格检查结果，将患者分为低风险组和高风险组。比较两种 CT 扫描在五个关键解剖结构方面的影像学发现。
共有 180 名符合纳入标准的患者，其中 120 名患者分为低风险组。在低风险组中，创伤全扫描 CT 对以下五个关键解剖结构骨折受累的阴性预测值如下：骨迷路（1.000）、颈动脉管（0.960）、面神经管（1.000）、听小骨链（0.992）和鼓室盖（0.856）。低风险组患者进行专门的颞骨 CT 成像的年自付费用估计约为 34,000 美元，在整个研究期间总计为 190,000 美元。
在低风险患者中，创伤全扫描 CT 可能足以识别颞骨骨折与颞骨关键解剖结构的受累情况。减少专门的颞骨成像将减少创伤患者的辐射暴露和放射科部门的压力。
4 级喉镜，131：E278-E282，2021 年。
