计算机断层血管造影术在检测肢体创伤患者临床相关血管损伤方面的附加效用较低。
Computed tomography angiography is associated with low added utility for detecting clinically relevant vascular injuries among patients with extremity trauma.
作者信息
Brian Riley, Bennett Daniel J, Kim Woon Cho, Stein Deborah M
机构信息
Department of Surgery, University of California San Francisco, San Francisco, California, USA.
School of Medicine, University of California San Francisco, San Francisco, California, USA.
出版信息
Trauma Surg Acute Care Open. 2021 Dec 20;6(1):e000828. doi: 10.1136/tsaco-2021-000828. eCollection 2021.
BACKGROUND
Extremity CT angiography (CTA) is frequently used to assess for vascular injury among patients with extremity trauma. The injured extremity index (IEI), defined as the ratio of systolic occlusion pressure between injured and uninjured extremities, has been implemented to screen patients being considered for CTA. Physical examination together with IEI is extremely sensitive for significant extremity vascular injury. Unfortunately, IEI cannot always be calculated. This study aimed to determine whether patients with normal pulse examinations and no hard signs of vascular injury benefitted from further imaging with CTA. We hypothesized that CTA has become overused among patients with extremity trauma, as determined by the outcome of vascular abnormalities that underwent vascular intervention but were missed by physical examination.
METHODS
The charts of traumatically injured patients who underwent extremity CTA were retrospectively reviewed. This study was performed at a level 1 trauma center for patients who presented as trauma activations from September 1, 2019 to September 1, 2020.
RESULTS
One hundred and thirty-six patients with 167 injured limbs were included. Eight limbs (4.8%) underwent an open vascular operation, whereas five limbs (3.0%) underwent an endovascular procedure. One of the 167 limbs (0.6%) had a vascular injury seen on CTA and underwent intervention that was not associated with a pulse abnormality or hard signs of vascular injury. This patient presented in a delayed fashion after an initially normal IEI and examination. Proximity injuries and fractures alone were not highly associated with vascular injuries.
DISCUSSION
Many patients with normal pulse examination and no hard signs of vascular injury underwent CTA; the vast majority of these patients did not then have a vascular intervention. Given the consequences of missed vascular injuries, further work is required to prospectively assess the utility of CTA among patients with extremity trauma.
LEVEL OF EVIDENCE
III.
背景
肢体CT血管造影（CTA）常用于评估肢体创伤患者的血管损伤情况。损伤肢体指数（IEI）定义为受伤肢体与未受伤肢体收缩期闭塞压之比，已用于筛选考虑进行CTA检查的患者。体格检查结合IEI对严重肢体血管损伤极为敏感。不幸的是，IEI并非总能计算得出。本研究旨在确定脉搏检查正常且无血管损伤硬体征的患者是否能从CTA进一步成像中获益。我们假设，根据血管异常的结果判断，CTA在肢体创伤患者中已被过度使用，这些血管异常在体格检查中被遗漏，但随后接受了血管介入治疗。
方法
回顾性分析接受肢体CTA检查的创伤患者的病历。本研究在一家一级创伤中心进行，研究对象为2019年9月1日至2020年9月1日因创伤而就诊的患者。
结果
纳入136例患者，共167条受伤肢体。8条肢体（4.8%）接受了开放性血管手术，5条肢体（3.0%）接受了血管内介入治疗。167条肢体中有1条（0.6%）在CTA上显示有血管损伤并接受了介入治疗，该损伤与脉搏异常或血管损伤硬体征无关。该患者最初IEI和检查正常，但就诊延迟。单纯的临近损伤和骨折与血管损伤的相关性不高。
讨论
许多脉搏检查正常且无血管损伤硬体征的患者接受了CTA检查；这些患者中的绝大多数随后并未接受血管介入治疗。鉴于漏诊血管损伤的后果，需要进一步开展工作，前瞻性评估CTA在肢体创伤患者中的应用价值。
证据级别
III级。
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