Indiana University School of Medicine and Indiana University Health, Indianapolis, IN, USA.
Emerg Radiol. 2021 Apr;28(2):265-272. doi: 10.1007/s10140-020-01847-5. Epub 2020 Aug 28.
The aims of this study are to determine the incidence of lower extremity fractures and/or vascular injuries in the setting of whole body computed tomography (WBCT) for trauma and to determine lower extremity injury outcomes in this patient population.
This is a retrospective observational study performed at a large urban Level 1 trauma center. Our institutional trauma registry was queried for patients who were evaluated with WBCT and lower extremity CT angiography (CTA) as a part of their initial imaging evaluation over a 43-month period. Patients with lower extremity fractures and/or vascular injuries were identified. Those patients with both lower extremity vascular injury and fracture were then analyzed to determine the physical relationship of the fracture to the vascular injury. Physical exam findings were extracted from the medical record. Interventions and long-term outcomes were determined from the medical record.
A total of 370 patients met the inclusion criteria, with 98% experiencing blunt trauma. Of these, 290 (78.4%) were positive for lower extremity injury, including 266 (71.9%) with isolated fractures, 2 (0.6%) with isolated vascular injury, and 22 (5.9%) with vascular injury associated with long bone fracture. Of the 22 patients with combined fracture and vascular injury, 8 received vascular intervention and 10 had long-term complications as a result of their injuries. Physical exam findings were insufficient to diagnose 57% of the vascular injuries.
The inclusion of lower extremity CTA as part of a WBCT imaging exam for trauma allows for the identification of vascular injuries that otherwise may have gone undetected or resulted in delayed diagnosis. Clinically occult lower extremity vascular injuries may be associated with poor outcomes.
本研究旨在确定全身计算机断层扫描（WBCT）用于创伤检查时下肢骨折和/或血管损伤的发生率，并确定该患者人群下肢损伤的结局。
这是在一家大型城市一级创伤中心进行的回顾性观察性研究。在 43 个月的时间内，通过我们的机构创伤登记处查询了接受 WBCT 和下肢 CT 血管造影（CTA）检查作为初始影像学评估一部分的患者。确定存在下肢骨折和/或血管损伤的患者。然后分析那些下肢血管损伤和骨折并存的患者，以确定骨折与血管损伤的物理关系。从病历中提取体格检查结果。从病历中确定干预措施和长期结局。
共有 370 名患者符合纳入标准，其中 98%为钝性创伤。在这些患者中，290 名（78.4%）存在下肢损伤，包括 266 名（71.9%）单纯骨折、2 名（0.6%）单纯血管损伤和 22 名（5.9%）血管损伤合并长骨骨折。在 22 名合并骨折和血管损伤的患者中，8 名接受了血管介入治疗，10 名因受伤导致长期并发症。体格检查结果不足以诊断 57%的血管损伤。
将下肢 CTA 纳入 WBCT 成像检查的一部分用于创伤检查，可以发现否则可能未被发现或导致诊断延迟的血管损伤。临床隐匿性下肢血管损伤可能与不良结局相关。
