Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.
Eur J Trauma Emerg Surg. 2021 Dec;47(6):1813-1817. doi: 10.1007/s00068-020-01371-8. Epub 2020 Apr 16.
Bowel and mesenteric injuries are rare in patients following blunt abdominal trauma. Computed tomography (CT) imaging has become a mainstay in the work-up of the stable trauma patient. The purpose of this study was to identify radiographic predictors of therapeutic operative intervention for mesenteric and/or bowel injuries in patients after blunt abdominal trauma.
All patients with a discharge diagnosis of bowel and/or mesenteric injury after blunt trauma were identified over a 5-year period. Admission CT scans were reviewed to identify potential predictors of bowel and/or mesenteric injury. Patients were then stratified by operative intervention [therapeutic laparotomy (TL) vs. non-therapeutic laparotomy (NTL)] and compared. All potential predictors included in the initial regression model were assigned one point and a score based on the number of predictors was calculated: the radiographic predictors of therapeutic operative intervention (RAPTOR) score.
151 patients were identified. 114 (76%) patients underwent operative intervention. Of these, 75 patients (66%) underwent TL. Multifocal hematoma, acute arterial extravasation, bowel wall hematoma, bowel devascularization, fecalization, pneumoperitoneum and fat pad injury, identified as potential predictors on univariable analysis, were included in the initial regression model and comprised the RAPTOR score. The optimal RAPTOR score was identified as ≥ 3, with a sensitivity, specificity and positive predictive value of 67%, 85% and 86%, respectively. Acute arterial extravasation (OR 3.8; 95% CI 1.2-4.3), bowel devascularization (OR 14.5; 95% CI 11.8-18.4) and fat pad injury (OR 4.5 95% CI 1.6-6.2) were identified as independent predictors of TL (AUC 0.91).
CT imaging remains vital in assessing for potential bowel and/or mesenteric injuries following blunt abdominal trauma. The RAPTOR score provides a simplified approach to predict the need for early therapeutic operative intervention.
肠和肠系膜损伤在钝性腹部创伤后的患者中很少见。计算机断层扫描（CT）成像已成为稳定创伤患者检查的主要手段。本研究的目的是确定钝性腹部创伤后患者肠系膜和/或肠损伤治疗性手术干预的影像学预测因素。
在 5 年期间，确定了所有因钝性创伤后出现肠和/或肠系膜损伤的出院诊断的患者。回顾入院 CT 扫描，以确定肠和/或肠系膜损伤的潜在预测因素。然后根据手术干预（治疗性剖腹手术[TL]与非治疗性剖腹手术[NTL]）对患者进行分层，并进行比较。初始回归模型中包含的所有潜在预测因素均被赋值为 1 分，并根据预测因素的数量计算评分：治疗性手术干预的影像学预测因素（RAPTOR）评分。
共确定了 151 名患者。114 名（76%）患者接受了手术干预。其中，75 名患者（66%）接受了 TL。多灶性血肿、急性动脉外渗、肠壁血肿、肠缺血、粪便化、气腹和脂肪垫损伤，在单变量分析中被确定为潜在预测因素，被纳入初始回归模型，并构成 RAPTOR 评分。最佳 RAPTOR 评分为≥3，其敏感性、特异性和阳性预测值分别为 67%、85%和 86%。急性动脉外渗（OR 3.8；95%CI 1.2-4.3）、肠缺血（OR 14.5；95%CI 11.8-18.4）和脂肪垫损伤（OR 4.5；95%CI 1.6-6.2）被确定为 TL 的独立预测因素（AUC 0.91）。
CT 成像在评估钝性腹部创伤后潜在的肠和/或肠系膜损伤仍然至关重要。RAPTOR 评分提供了一种简化的方法来预测早期治疗性手术干预的需求。
