Ledrick David, Payvandi Alexander, Murray Adam C, Leskovan John J
Department of Emergency Medicine, Mercy St. Vincent Medical Center, Toledo, USA.
Department of Trauma Surgery, Mercy St. Vincent Medical Center, Toledo, USA.
Cureus. 2020 Nov 22;12(11):e11628. doi: 10.7759/cureus.11628.
Background Clinically significant injuries are often missed in trauma patients with low-risk mechanisms of injury and lack of "red flags," such as abnormal vital signs. The purpose of this retrospective analysis was to evaluate the efficacy of computed axial tomography (CT) for identifying occult injuries in a high-volume trauma center. Methods Records from our institutional trauma registry were retrospectively extracted, examining encounters from January 2015 to October 2019. Those patients between the ages of 18 and 65 who were referred to the trauma team with a CT scan of the abdomen and had low-risk mechanisms of injury, a Glasgow Coma Scale (GCS) score of 15, and normal vital signs at presentation were included. Patients in the lowest trauma categorization (Level Three, Consult) met the study definition for the low-risk mechanism of injury. Demographic and clinical data were abstracted for all patients. For this analysis, patients were divided into two groups based on age (18 - 40 years or 40 - 65 years). Injuries found on CT, their clinical significance, and the likelihood of being missed without CT were determined. Results Of 2,103 blunt trauma patients that received a CT scan of the abdomen from January 2015 to October 2019, 134/2,103 (6.4%) met the inclusion criteria (mean age: 44.6 years; 72.3% male). Patients between the ages of 40 and 65 years comprised 61.2% (82/134) of the study population. Of the included patients, 17.2% (23/134) had at least one acute traumatic injury identified after CT imaging of the torso. Occult injuries found on CT included rib fracture with associated lung injuries (10/23, 43.5%), splenic laceration (4/23, 17.4%), liver laceration (3/23, 13.0%), gluteal hematoma with active bleeding (1/23, 4.3%), sternal fractures (3/23, 13.0%), and thoracic or lumbar spine fractures (2/23, 8.7%). An independent review of the medical records determined that 9.0% (12/134) of these patients had traumatic injuries that would have been missed based on clinical examination without CT. Conclusions Based on our experience, utilizing CT imaging of at least the abdomen as a routine screening measure for all trauma consults - even low-risk patients with normal vital signs - can rapidly and accurately identify clinically significant injuries that would have been otherwise missed in a notable portion of the population.
在损伤机制风险较低且缺乏“红旗”表现（如生命体征异常）的创伤患者中，具有临床意义的损伤常常被漏诊。本回顾性分析的目的是评估在一家高容量创伤中心，计算机断层扫描（CT）识别隐匿性损伤的有效性。方法：回顾性提取我们机构创伤登记处的记录，检查2015年1月至2019年10月期间的病例。纳入年龄在18至65岁之间、因腹部CT扫描被转诊至创伤团队、损伤机制风险较低、格拉斯哥昏迷量表（GCS）评分为15分且就诊时生命体征正常的患者。创伤分类最低（三级，会诊）的患者符合低风险损伤机制的研究定义。提取所有患者的人口统计学和临床数据。在此分析中，根据年龄（18 - 40岁或40 - 65岁）将患者分为两组。确定CT检查发现的损伤、其临床意义以及无CT检查时漏诊的可能性。结果：在2015年1月至2019年10月接受腹部CT扫描的2103例钝性创伤患者中，134/2103（6.4%）符合纳入标准（平均年龄：44.6岁；72.3%为男性）。年龄在40至65岁之间的患者占研究人群的61.2%（82/134）。在所纳入的患者中，17.2%（23/134）在躯干CT成像后发现至少一处急性创伤性损伤。CT检查发现的隐匿性损伤包括伴有相关肺损伤的肋骨骨折（10/23，43.5%）、脾撕裂伤（4/23，17.4%）、肝撕裂伤（3/23，13.0%）、伴有活动性出血的臀肌血肿（1/23，4.3%）、胸骨骨折（3/23，13.0%）以及胸椎或腰椎骨折（2/23，8.7%）。对病历的独立审查确定，这些患者中有9.0%（12/134）的创伤性损伤若不进行CT检查仅凭临床检查将会被漏诊。结论：根据我们的经验，将至少腹部的CT成像作为所有创伤会诊病例（即使是生命体征正常的低风险患者）的常规筛查措施，能够快速、准确地识别出在相当一部分人群中可能会被漏诊的具有临床意义的损伤。
