CT 血管造影在穿透性下肢创伤中的应用价值。

Yield of CT angiography in penetrating lower extremity trauma.

机构信息

Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.

出版信息

Emerg Radiol. 2021 Aug;28(4):743-749. doi: 10.1007/s10140-021-01902-9. Epub 2021 Feb 22.

DOI:10.1007/s10140-021-01902-9

PMID:33619684

Abstract

PURPOSE

CT angiography (CTA) has become a valuable tool in the assessment of suspected arterial injury in patients with penetrating lower extremity trauma. However, expensive imaging such as CTA should be judiciously utilized to ensure value-based care. We therefore assessed the yield of CTA in this setting at a level-1 trauma unit and correlated it with the clinical history provided.

METHODS

A retrospective descriptive study from 1 July 2013 to 31 June 2018 at a 1386-bed, tertiary-level, public-sector teaching hospital in Cape Town, South Africa.. All patients undergoing CTA for suspected arterial injury following penetrating lower extremity trauma were included. The imaging yield of clinically significant arterial injury and the predictive value of specific clinical signs were determined.

RESULTS

A total of 983 patients (median age 27 years, 91% male) were included; 90% (886/983) had gunshots, 9% (89/983) stabs, and 1% (8/983) other injuries. Despite an average 13% year-on-year increase in CTA performed, there was no change in the proportion demonstrating arterial injury. Thirty-four percent (23/68) of patients with strong (hard) signs of arterial injury (active pulsatile bleeding, rapidly expanding hematoma, absent pulse, palpable thrill, or audible bruit), 11% (49/459) with moderate (soft) signs (history of an arterial bleed, excessive non-pulsatile bleeding, large non-expanding hematoma, major neurological deficit, diminished but appreciable pulse, and arterial proximity), and 5% (24/456) with no indication for imaging had clinically significant arterial injuries. Significant positive correlations were rapidly expanding hematoma (p = 0.009), an absent pulse (p < 0.001), and a diminished pulse (p < 0.001). Significant negative correlations were proximity to a major artery (p = 0.005) and no clinical indication provided (p < 0.001).

CONCLUSION

There is poor correlation between clinical details provided and the presence of arterial injury at our institution. In this context, CTA serves a pivotal role in the definitive identification of arterial injury.

摘要

目的

CT 血管造影（CTA）已成为评估有穿透性下肢创伤的疑似动脉损伤患者的有价值的工具。然而，像 CTA 这样昂贵的影像学检查应该谨慎使用，以确保基于价值的护理。因此，我们评估了一级创伤单位中 CTA 的检出率，并将其与提供的临床病史进行了相关性分析。

方法

这是一项 2013 年 7 月 1 日至 2018 年 6 月 31 日在南非开普敦一家拥有 1386 张床位的三级公立教学医院进行的回顾性描述性研究。所有因穿透性下肢创伤后疑似动脉损伤而接受 CTA 检查的患者均被纳入研究。确定了有临床意义的动脉损伤的影像学检出率和特定临床体征的预测价值。

结果

共纳入 983 例患者（中位年龄 27 岁，91%为男性）；90%（886/983）为枪击伤，9%（89/983）为刺伤，1%（8/983）为其他损伤。尽管每年进行 CTA 的比例平均增长了 13%，但显示动脉损伤的比例没有变化。34%（23/68）有强烈（硬性）动脉损伤体征（活跃性搏动性出血、迅速扩大的血肿、无脉搏、可触及震颤或可闻及杂音），11%（49/459）有中度（软性）体征（动脉出血史、非搏动性大量出血、非扩张性大血肿、严重神经功能缺损、可触及但明显减弱的脉搏和动脉接近），5%（24/456）无影像学检查指征的患者存在有临床意义的动脉损伤。迅速扩大的血肿（p = 0.009）、无脉搏（p < 0.001）和脉搏减弱（p < 0.001）与阳性结果有显著相关性。与主要动脉接近（p = 0.005）和无临床指征（p < 0.001）与阴性结果有显著相关性。