Department of Trauma and Orthopaedics, Princess Alexandra Hospital NHS Foundation Trust, London, United Kingdom.
Department of Trauma and Orthopaedics, Princess Alexandra Hospital NHS Foundation Trust, London, United Kingdom.
Chin J Traumatol. 2021 Sep;24(5):249-254. doi: 10.1016/j.cjtee.2021.04.010. Epub 2021 Apr 25.
There are currently no clear guidelines for use of pan- or selective CT in elderly trauma patients and this subject matter remains controversial. The aim of this study is to compare the outcome of elderly trauma patients in a level 1 trauma centre who required a pan- or selective CT scan on admission.
The Trauma Audit Research Network database was reviewed to identify eligible patients (≥65 years) over a one-year period, from January 2018 to January 2019. Patients' demographics, mechanism of injury, injury severity score, length of hospital stay (LOS), mortality and type of CT scans done were recorded. The inclusion criteria were elderly patients ≥65 years involved in acute trauma setting (less than one day between incident and emergency department presentation and blunt mechanism of injury). Exclusion criteria were patients <65 years, perforating mechanism of injury and patients with delayed presentation more than one day after the incident, and patients who have not got any CT scan at presentation. Statistical analyses were undertaken on SPSS (version 25.0; IBM, New York, USA).
In total, 481 patients with the mean age of 80.8 years were evaluated (48.6% male). Among them 232 cases were multiple injuries while 249 were single system injuries. And 235 patients (48.8%) underwent pan-CT in whom 66.8% were multiple injuries; 246 (51.1%) did selective CT scan in whom 69.5% were single system injuries. In multiple injury patients, performing a pan-CT scan on presentation was associated with shorter LOS compared to those who had a selective CT, in which 76.4% patients spent < 21 days in the pan-CT group compared to 16.0% for those investigated by selective CT scan (p < 0.001); and 2.5% spent > 60 days in pan-CT group compared to 64% in selective CT group (p < 0.0001). Performing pan-CT was also associated with lower need to repeat CT (p < 0.01). In patients with a single system injury, no differences were found in LOS or the need to repeat CT if either pan-CT or selective CT were requested.
We recommend doing pan-CT scan in all elderly patients with multiple system injuries as it decreases the LOS and the need for another CT during hospital stay. No difference in LOS or the need to repeat another CT if pan-CT or selective CT were requested initially in single system injuries. Although age and injury severity score are poor predictors for the need to do pan-CT, the mechanism of injury may be helpful.
目前对于老年创伤患者行全腹部或选择性 CT 检查并无明确的使用指南，该问题仍存在争议。本研究旨在比较我院行全腹部或选择性 CT 检查的老年创伤患者的结局。
回顾性分析 2018 年 1 月至 2019 年 1 月我院创伤患者数据库中符合条件的患者（≥65 岁）。记录患者的人口统计学、损伤机制、损伤严重程度评分、住院时间（LOS）、死亡率和所行 CT 类型。纳入标准为年龄≥65 岁、急性创伤患者（受伤至急诊就诊时间<1 天，钝性损伤机制）。排除标准为年龄<65 岁、贯通伤机制和>1 天延迟就诊患者，以及就诊时未行任何 CT 检查的患者。统计学分析采用 SPSS （版本 25.0；IBM，纽约，美国）。
共评估了 481 例患者，平均年龄为 80.8 岁（48.6%为男性）。其中 232 例为多发伤，249 例为单系统伤。235 例（48.8%）患者行全腹部 CT 检查，其中 66.8%为多发伤；246 例（51.1%）行选择性 CT 检查，其中 69.5%为单系统伤。多发伤患者中，与行选择性 CT 检查的患者相比，行全腹部 CT 检查的 LOS 更短，其中 76.4%的患者在全腹部 CT 组的 LOS<21 天，而选择性 CT 组为 16.0%（p<0.001）；2.5%的患者在全腹部 CT 组的 LOS>60 天，而选择性 CT 组为 64%（p<0.0001）。行全腹部 CT 检查也与需要重复 CT 检查的次数减少相关（p<0.01）。对于单系统伤患者，如果行全腹部 CT 或选择性 CT 检查，其 LOS 或需要重复 CT 检查的差异无统计学意义。
我们建议对所有多发伤的老年患者行全腹部 CT 检查，因为这可以缩短 LOS 并减少住院期间再次行 CT 检查的需要。如果在单系统伤中最初行全腹部 CT 或选择性 CT 检查，其 LOS 或需要再次行 CT 检查的差异无统计学意义。尽管年龄和损伤严重程度评分是预测是否行全腹部 CT 检查的不良指标，但损伤机制可能具有一定的提示作用。
