Maghraby Nisreen H, Alshaqaq Hassan M, AlQattan Abdullah Saleh, Alfaraj Adnan Fawzi, Alghamdi Omar A, Alzawad Malak J, Farcy David A
Department of Emergency Medicine, King Fahd University Hospital-College of Medicine, Imam Abdulrahman Bin Faisal University, AlKhobar, Kingdom of Saudi Arabia.
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
Open Access Emerg Med. 2020 Oct 23;12:305-313. doi: 10.2147/OAEM.S263754. eCollection 2020.
Whole-body computed tomography (WBCT) has been a mainstay and an integral part of the evaluation of polytrauma patients in trauma centers and emergency departments (ED) for a comprehensive evaluation of the extent of injuries. However, routine use of WBCT remains controversial since it exposes patients to radiation and exponentially increases financial expense. The primary objective was to determine the rate of negative WBCT in polytrauma patients.
A retrospective cohort study was conducted at an academic hospital in the Kingdom of Saudi Arabia, which is a dedicated trauma center with a mean of 237,392 ED visits and 10,714 trauma per year. The study included all adult (≥18 years) polytrauma patients who presented to our ED, requiring trauma team activation, and underwent WBCT as part of their evaluation from January 2016 to May 2017. We excluded pediatric patients, patients transferred from another facility, and pregnant patients. The primary endpoint was to measure the rate of negative WBCT in polytraumatized patients.
A total of 186 patients were included with a mean age of 28.8 ± 12.9 years. The rate of negative WBCT scans was 20.4%. The positive scans were subclassified based on the number of anatomical body regions that were affected radiologically. One body region was affected in 47 patients (31.8%), two body regions were affected in 50 patients (33.8%), and ≥3 body regions were affected in 51 patients (34.3%). In a subset analysis, we identified that oxygen saturation <94% and GCS ≤8 were associated with positive CT scans.
Our study revealed a slightly higher rate of utilization of WBCT in the management of trauma patients compared to studies with similar practice. We believe that in the correct setting with incorporating high index of suspicion, a physical examination with attention to vital signs and mental status, performing E-FAST, and dedicated X-Rays is a way to potentially reduce the use of WBCT in polytrauma patients.
全身计算机断层扫描（WBCT）一直是创伤中心和急诊科对多发伤患者进行评估的主要手段和不可或缺的一部分，用于全面评估损伤程度。然而，常规使用WBCT仍存在争议，因为它会使患者暴露于辐射之下，并大幅增加经济费用。主要目的是确定多发伤患者中WBCT结果为阴性的比例。
在沙特阿拉伯王国的一家学术医院进行了一项回顾性队列研究，该医院是一家专门的创伤中心，平均每年有237392次急诊科就诊和10714例创伤患者。该研究纳入了2016年1月至2017年5月期间所有成年（≥18岁）多发伤患者，这些患者到我们急诊科就诊，需要启动创伤团队，并接受WBCT作为评估的一部分。我们排除了儿科患者、从其他机构转来的患者和孕妇。主要终点是测量多发伤患者中WBCT结果为阴性的比例。
共纳入186例患者，平均年龄为28.8±12.9岁。WBCT扫描结果为阴性的比例为20.4%。阳性扫描结果根据放射学上受影响的解剖身体区域数量进行分类。47例患者（31.8%）有一个身体区域受影响，50例患者（33.8%）有两个身体区域受影响，51例患者（34.3%）有≥3个身体区域受影响。在亚组分析中，我们发现血氧饱和度<94%和格拉斯哥昏迷评分（GCS）≤8与CT扫描阳性相关。
我们的研究表明，与类似实践的研究相比，在创伤患者管理中WBCT的使用率略高。我们认为，在结合高度怀疑指数的正确情况下，进行关注生命体征和精神状态的体格检查、实施急诊创伤超声重点评估（E-FAST）以及进行专门的X线检查，是一种有可能减少多发伤患者WBCT使用的方法。
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