University Hospitals Birmingham NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2022 Feb;104(2):100-105. doi: 10.1308/rcsann.2021.0127. Epub 2021 Nov 3.
The clinical presentation of lower gastrointestinal bleeding (LGIB) is variable in severity, cause and potential investigations. The British Society of Gastroenterology recently published LGIB guidelines, recommending CT angiography (CT-A) for haemodynamically unstable patients, defined by shock index (SI) greater than 1. The aim of this study was to assess the use and role of CT-A in diagnosing LGIB, by assessing the pickup rate of active LGIB defined by contrast extravasation or 'blush' and to determine any association between positive CT-A with various patient and clinical characteristics.
A retrospective analysis was carried out of 4 years of LGIB admissions. Demographics, inpatient observations and use of blood products were acquired. Vital signs nearest the time of CT-A plus abnormal vital signs preceding imaging were used to calculate SI, Age SI, National Early Warning Score 2 (NEWS2) and Standardised Early Warning Score (SEWS). A consultant gastrointestinal radiologist further reviewed all consultant-reported scans.
In total, 930 patients were admitted with LGIB. Median age was 71 years and 51% were male; 179 (19.2%) patients received red blood cell transfusion and 93 patients (10%) underwent CT-A, who were older and were likely to be hypotensive and receive red cell transfusions. Following exclusions, 92 CT-As were included in the analysis. Nine (9.8%) were positive. Univariate analysis showed no association between positive CT-A and any scoring system. A multivariate analysis, including age and gender, showed association between both NEWS2 and SEWS scores with positive CT-A.
In our analysis of the typical LGIB population, CT-A has shown relatively low pick up rate of active bleeding. CT-A clearly has a role in the investigation of LGIB, but selection remains challenging.
下消化道出血（LGIB）的临床表现因严重程度、病因和潜在检查而异。英国胃肠病学会最近发布了 LGIB 指南，建议对休克指数（SI）大于 1 的血流动力学不稳定患者进行 CT 血管造影（CT-A）检查。本研究旨在通过评估对比外渗或“红晕”定义的活动性 LGIB 的检出率来评估 CT-A 在诊断 LGIB 中的作用，并确定阳性 CT-A 与各种患者和临床特征之间的任何关联。
对 4 年来 LGIB 住院患者进行回顾性分析。获取人口统计学资料、住院观察和血液制品使用情况。使用 CT-A 前后最近的生命体征和异常生命体征来计算 SI、年龄 SI、国家早期预警评分 2（NEWS2）和标准化早期预警评分（SEWS）。一名顾问级胃肠放射科医生进一步回顾了所有顾问报告的扫描。
共有 930 名患者因 LGIB 入院。中位年龄为 71 岁，51%为男性；179 名（19.2%）患者接受了红细胞输注，93 名（10%）患者接受了 CT-A，这些患者年龄较大，可能低血压并接受红细胞输注。排除后，共纳入 92 例 CT-A 进行分析。9 例（9.8%）为阳性。单因素分析显示阳性 CT-A 与任何评分系统均无关联。包括年龄和性别在内的多变量分析显示，NEWS2 和 SEWS 评分与阳性 CT-A 均有关联。
在对典型 LGIB 人群的分析中，CT-A 显示出相对较低的活动性出血检出率。CT-A 在 LGIB 的检查中显然具有一定作用，但选择仍然具有挑战性。
