Department of Emergency Surgery & Traumatic Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China.
Department of Emergency Surgery & Traumatic Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China.
Chin J Traumatol. 2021 May;24(3):136-139. doi: 10.1016/j.cjtee.2021.03.002. Epub 2021 Mar 13.
Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury. CT has been applied for several decades to evaluate blunt pelvic trauma patients. However, it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury (HVI), especially in the early stage after injury. The delayed diagnosis of HVI could result in a high morbidity and mortality. The bowel injury prediction score (BIPS) applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary. We recently found another clinical variable (iliac ecchymosis, IE) which appeared at the early stage of injury, could be predicted for HVI. The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI, and thus reduce complications and mortalities.
We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital. The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention. The exclusion criteria were abdominal CT insufficiency before operation, abdominal surgery before CT scan, and CT mesenteric injury grade being 5. The MBIPS was defined as BIPS plus IE, which was calculated according to 4 variables: white blood cell counts of 17.0 or greater, abdominal tenderness, CT scan grade for mesenteric injury of 4 or higher, and the location of IE. Each clinical variable counted 1 score, totally 4 scores. The location and severity of IE was also noted.
In total, 635 cases were hospitalized and 62 patients were enrolled in this study. Of these included patients, 77.4% (40 males and 8 females) were operated by exploratory laparotomy and 22.6% (8 males and 6 females) were treated conservatively. In the 48 patients underwent surgical intervention, 46 were confirmed with HVI (45 with IE and 1 without IE). In 46 patients confirmed without HVI, only 3 patients had IE and the rest had no IE. The sensitivity and specificity of IE in predicting HVI was calculated as 97.8% (45/46) and 81.3% (13/16), respectively. The median MBIPS score for surgery group was 2, while 0 for the conservative treatment group. The incidence of HVI in patients with MBIPS score ≥ 2 was significantly higher than that in patients with MBIPS score less than ≤ 2 (OR = 17.3, p < 0.001).
IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity, which is a valuable sign for HVI in blunt pelvic trauma patients. MBIPS can be used to predict HVI in blunt pelvic trauma patients. When the MBIPS score is ≥ 2, HVI is strongly suggested.
骨盆骨折的特点是高能量损伤，常伴有腹部和骨盆器官损伤。几十年来，CT 一直被用于评估钝性骨盆创伤患者。然而，它对腹部空腔脏器损伤（HVI）的诊断准确率存在一定的偏差，尤其是在损伤的早期阶段。HVI 的延迟诊断可能导致高发病率和死亡率。肠损伤预测评分（BIPS）应用 3 个临床变量来确定是否需要对钝性 HVI 进行早期手术干预。我们最近发现了另一个临床变量（骼腰肌瘀斑，IE），它在损伤的早期阶段出现，可用于预测 HVI。本研究的主要目的是探讨 IE 和 BIPS 的新组合，以提高 HVI 的早期诊断率，从而降低并发症和死亡率。
我们对 2008 年 1 月至 2018 年 12 月期间我院收治的钝性骨盆创伤患者进行了回顾性分析。纳入标准为在任何手术干预之前，在急诊科使用腹部和骨盆 CT 扫描证实骨盆骨折的患者。排除标准为术前腹部 CT 不足、腹部手术前 CT 扫描、肠系膜损伤 CT 分级为 5 级。MBIPS 定义为 BIPS 加 IE，根据 4 个变量计算：白细胞计数 17.0 或更高、腹部压痛、肠系膜损伤 CT 分级为 4 级或更高、IE 的位置。每个临床变量计 1 分，共 4 分。IE 的位置和严重程度也被记录下来。
共有 635 例患者住院，62 例患者纳入本研究。在这些纳入的患者中，77.4%（40 名男性和 8 名女性）接受了剖腹探查术，22.6%（8 名男性和 6 名女性）接受了保守治疗。在 48 例接受手术干预的患者中，46 例被证实有 HVI（45 例有 IE，1 例无 IE）。在 46 例证实无 HVI 的患者中，只有 3 例有 IE，其余患者均无 IE。IE 预测 HVI 的敏感性和特异性分别为 97.8%（45/46）和 81.3%（13/16）。手术组的 MBIPS 中位数为 2，而保守治疗组为 0。MBIPS 评分≥2 的患者 HVI 的发生率明显高于 MBIPS 评分≤2 的患者（OR=17.3，p<0.001）。
IE 可被视为 HVI 的间接征象，因为其具有较高的敏感性和特异性，是钝性骨盆创伤患者中 HVI 的一个有价值的征象。MBIPS 可用于预测钝性骨盆创伤患者的 HVI。当 MBIPS 评分≥2 时，强烈提示 HVI。
