多车辆碰撞后钝器创伤中全身计算机断层扫描的利用趋势：创伤质量改进计划数据库分析。
Trends in utilization of whole-body computed tomography in blunt trauma after MVC: Analysis of the Trauma Quality Improvement Program database.
机构信息
From the Burn and Shock Trauma Research Institute (C.B., R.G., F.A.L.), Loyola University Chicago, Chicago; Department of Surgery (C.B., B.R., P.P., M.B., R.G., F.A.L.), Department of Thoracic and Cardiovascular Surgery (Z.M.A.), Loyola University Medical Center, Maywood; and Edward Hines Jr. Veterans Affair Hospital (M.B., Z.M.A., F.A.L.), Hines, Illinois.
出版信息
J Trauma Acute Care Surg. 2021 Jun 1;90(6):951-958. doi: 10.1097/TA.0000000000003129.
BACKGROUND
The use of whole-body computed tomography (WBCT) in awake, clinically stable injured patients is controversial. It is associated with unnecessary radiation exposure and increased cost. We evaluate use of computed tomography (CT) imaging during the initial evaluation of injured patients at American College of Surgeons Levels I and II trauma centers (TCs) after blunt trauma.
METHODS
We identified adult blunt trauma patients after motor vehicle crash (MVC) from the American College of Surgeons Trauma Quality Improvement Program (TQIP) database between 2007 and 2016 at Level I or II TCs. We defined awake clinically stable patients as those with systolic blood pressure of 100 mm Hg or higher with a Glasgow Coma Scale score of 15. Computed tomography imaging had to have been performed within 2 hours of arrival. Whole-body computed tomography was defined as simultaneous CT of the head, chest and abdomen, and selective CT if only one to two aforementioned regions were imaged. Patients were stratified by Injury Severity Score (ISS).
RESULTS
There were 217,870 records for analysis; 131,434 (60.3%) had selective CT, and 86,436 (39.7%) had WBCT. Overall, there was an increasing trend in WBCT utilization over the study period (p < 0.001). In patients with ISS less than 10, WBCT was utilized more commonly at Level II versus Level I TCs in patients discharged from the emergency department (26.9% vs. 18.3%, p < 0.001), which had no surgical procedure(s) (81.4% vs. 80.3%, p < 0.001) and no injury of the head (53.7% vs. 52.4%, p = 0.008) or abdomen (83.8% vs. 82.1%, p = 0.001). The risk-adjusted odds of WBCT was two times higher at Level II TC vs. Level I (odds ratio, 1.88; 95% confidence interval 1.82-1.94; p < 0.001).
CONCLUSION
Whole-body computed tomography utilization is increasing relative to selective CT. This increasing utilization is highest at Level II TCs in patients with low ISSs, and in patients without associated head or abdominal injury. The findings have implications for quality improvement and cost reduction.
LEVEL OF EVIDENCE
Care management, Level IV.
背景
在清醒且临床稳定的受伤患者中使用全身计算机断层扫描（WBCT）存在争议。它与不必要的辐射暴露和增加的成本有关。我们评估了美国外科医师学院一级和二级创伤中心（TC）在钝性创伤后对受伤患者初始评估中 CT 成像的使用情况。
方法
我们从美国外科医师学院创伤质量改进计划（TQIP）数据库中确定了 2007 年至 2016 年期间在一级或二级 TC 发生机动车碰撞（MVC）后的成年钝性创伤患者。我们将清醒且临床稳定的患者定义为收缩压为 100mmHg 或更高，格拉斯哥昏迷量表评分为 15 分。CT 成像必须在到达后 2 小时内进行。全身 CT 定义为头部、胸部和腹部的同时 CT，如果仅对上述一个或两个区域进行成像，则定义为选择性 CT。根据损伤严重程度评分（ISS）对患者进行分层。
结果
分析了 217870 份记录；其中 131434 份（60.3%）进行了选择性 CT，86436 份（39.7%）进行了 WBCT。总体而言，在研究期间，WBCT 的使用率呈上升趋势（p<0.001）。在 ISS 小于 10 的患者中，与一级 TC 相比，二级 TC 更常对从急诊出院的患者进行 WBCT（26.9%比 18.3%，p<0.001），这些患者没有进行任何手术（81.4%比 80.3%，p<0.001），头部（53.7%比 52.4%，p=0.008）或腹部（83.8%比 82.1%，p=0.001）无损伤。与一级 TC 相比，二级 TC 进行 WBCT 的风险调整优势比为 2 倍（优势比，1.88；95%置信区间 1.82-1.94；p<0.001）。
结论
与选择性 CT 相比，全身 CT 的使用率正在增加。在 ISS 较低的患者和没有头部或腹部损伤的患者中，二级 TC 的使用率最高。这些发现对质量改进和成本降低具有重要意义。
证据水平
管理护理，IV 级。
Zotero 插件