Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
S Afr Med J. 2021 Sep 2;111(9):891-895.
The accuracy of physical examination to exclude arterial injury in penetrating trauma to extremities has been well established.
To determine whether the accuracy of physical examination to exclude arterial injury is similar to that of a computed tomography arteriogram (CTA) for different anatomical regions and mechanisms of injury, and in patients with concomitant fractures compared with those without.
A retrospective review was conducted on all patients who underwent CTA for penetrating injuries to an extremity between 1 June 2016 and 30 June 2017. The presence of arterial injuries was noted, and these were grouped into anatomical areas. Clinical notes were reviewed for the presence of hard signs of arterial injury at initial examination.
A total of 220 lower limb and 133 upper limb CTAs were included. The mean patient age was 28.9 years (range 11 - 68). The overall sensitivity of physical examination in detecting a CTA-confirmed arterial injury was 95.3% (95% confidence interval (CI) 88.4 - 98.7), with a specificity of 93.9% (95% CI 90.2 - 96.4). Physical examination of the thigh had the highest specificity of 96.4% (95% CI 91.8 - 98.8), followed by the lower leg at 94.4% (95% CI 81.3 - 99.3), the upper arm at 89.6% (95% CI 79.7 - 95.7) and the forearm at 77.8% (95% CI 40.0 - 97.2). For gunshot wounds the specificity was 96.1% (95% CI 92.4 - 98.3), while for stab wounds it was 86.8% (95% CI 74.7 - 94.5).
This study agrees with current literature indicating that physical examination has high specificity in detecting arterial injury in the setting of penetrating trauma to an extremity. However, it shows that the specificity is not equal for all anatomical regions or mechanisms of injury.
体格检查对外周穿透性创伤动脉损伤的排除准确性已得到充分证实。
确定体格检查排除动脉损伤的准确性是否与计算机断层血管造影（CTA）在不同解剖区域和损伤机制以及伴有和不伴有骨折的患者中相似。
对 2016 年 6 月 1 日至 2017 年 6 月 30 日期间因四肢穿透伤而行 CTA 的所有患者进行回顾性分析。记录动脉损伤的存在情况，并将其分为解剖区域。回顾临床记录，以确定初次检查时是否存在动脉损伤的硬体征。
共纳入 220 例下肢和 133 例上肢 CTA。患者平均年龄为 28.9 岁（范围 11-68 岁）。体格检查检测 CTA 证实的动脉损伤的总体敏感性为 95.3%（95%置信区间（CI）88.4-98.7），特异性为 93.9%（95%CI 90.2-96.4）。股部体格检查的特异性最高，为 96.4%（95%CI 91.8-98.8），其次是小腿为 94.4%（95%CI 81.3-99.3），上臂为 89.6%（95%CI 79.7-95.7），前臂为 77.8%（95%CI 40.0-97.2）。对于枪击伤，特异性为 96.1%（95%CI 92.4-98.3），而对于刺伤，特异性为 86.8%（95%CI 74.7-94.5）。
本研究与目前的文献一致，表明体格检查在外周穿透性创伤中检测动脉损伤具有很高的特异性。然而，它表明，特异性在不同的解剖区域或损伤机制中并不相等。
