Department of Surgery A, Emek Medical Center, Afula, 18101, Israel; Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, 31096, Israel.
Department of Surgery A, Emek Medical Center, Afula, 18101, Israel.
Chin J Traumatol. 2021 Sep;24(5):255-260. doi: 10.1016/j.cjtee.2021.03.009. Epub 2021 Apr 1.
Blunt thoracic injuries are common among elderly patients and may be a common cause of morbidity and death from blunt trauma injuries. We aimed to examine the impact of chest CT on the diagnosis and change of management plan in elderly patients with stable blunt chest trauma. We hypothesized that chest CT may play an important role in providing optimal management to this subgroup of trauma patients.
A retrospective analysis was performed on all the admitted adult blunt trauma patients between January 2014 and December 2018. Stable blunt chest trauma patients with abbreviated injury severity (AIS) < 3 for extra-thoracic injuries confirmed with chest X-ray (CXR) and chest CT on admission or during hospitalization were included in the study. The AIS is an international scale for grading the severity of anatomic injury following blunt trauma. Primary outcome variables were occult injuries, change in management, need for surgical procedures, missed injuries, readmission rate, intensive care unit (ICU) and length of hospital stay.
There are 473 patients with blunt chest trauma included in the study. The study patients were divided into two groups according to the age range: group 1: 289 patients were included and aged 18-64 years; group 2: 184 patients were included and aged 65-99 years . Elderly patients in group 2 more often required ICU admission (11.4% vs. 5.2%), had a longer length of ICU stay (days) (median 11 vs. 6, p = 0.01), and the length of hospital stay (days) (median 14 vs. 6, p = 0.04). Injuries identified on chest CT has led to a change of management in 4.4% of young patients in group 1 and in 10.9% of elderly patients in group 2 with initially normal CXR. Chest CT resulted in a change of management in 12.8% of young patients in group 1 and in 25.7% of elderly patients in group 2 with initially abnormal CXR.
Chest CT led to a change of management in a substantial proportion of elderly patients. Therefore, we recommend chest CT as a first-line imaging modality in patients aged over 65 years with isolated blunt chest trauma.
钝性胸部损伤在老年患者中较为常见，可能是钝性创伤损伤导致发病率和死亡率的常见原因。我们旨在研究胸部 CT 对稳定钝性胸部创伤老年患者的诊断和治疗计划改变的影响。我们假设胸部 CT 可能在为这一亚组创伤患者提供最佳治疗方面发挥重要作用。
对 2014 年 1 月至 2018 年 12 月期间所有入院的成人钝性创伤患者进行回顾性分析。稳定的钝性胸部创伤患者，其胸外损伤的简明损伤严重度评分（AIS）<3，入院时或住院期间经胸部 X 线（CXR）和胸部 CT 证实，包括在研究中。AIS 是一种用于分级钝性创伤后解剖损伤严重程度的国际量表。主要观察指标为隐匿性损伤、治疗方案改变、手术需求、漏诊、再入院率、重症监护病房（ICU）入住率和住院时间。
研究纳入 473 例钝性胸部创伤患者。根据年龄范围将研究患者分为两组：组 1：纳入 289 例，年龄 18-64 岁；组 2：纳入 184 例，年龄 65-99 岁。组 2 的老年患者更常需要入住 ICU（11.4%比 5.2%），入住 ICU 的时间（天）更长（中位数 11 比 6，p=0.01），住院时间（天）也更长（中位数 14 比 6，p=0.04）。胸部 CT 发现的损伤导致组 1 中 4.4%的年轻患者和组 2 中初始 CXR 正常的 10.9%的老年患者的治疗方案发生改变。胸部 CT 导致组 1 中 12.8%的年轻患者和组 2 中初始 CXR 异常的 25.7%的老年患者的治疗方案发生改变。
胸部 CT 导致相当一部分老年患者的治疗方案发生改变。因此，我们建议对于年龄大于 65 岁且单纯钝性胸部创伤的患者，将胸部 CT 作为一线影像学检查方法。
