Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of General Surgery, Kufa University of Medical Sciences, Najaf, Iraq.
Chin J Traumatol. 2022 May;25(3):170-176. doi: 10.1016/j.cjtee.2022.01.004. Epub 2022 Jan 19.
In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.
All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.
In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.
We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.
本研究重新评估了北美放射学会 (RSNA) 定义的标准，以确定有助于医生区分 COVID-19 与肺挫伤的新的放射学发现。
本回顾性研究纳入了 2020 年 2 月至 5 月间因钝性胸部创伤和随后的肺挫伤、COVID-19 相关症状而就诊的所有创伤患者。将符合纳入标准的患者（P 组）根据聚合酶链反应（PCR）检测结果分为阳性组（Pa 组）和阴性组（Pb 组）。此外，还纳入了来自大流行前时期（PP 组）的 44 名患者。根据年龄、性别和创伤评分对 P 组和 PP 组进行匹配。两名放射科医生根据 RSNA 标准对所有纳入患者的 CT 图像进行了盲法评估。比较 P 组和 PP 组之间的放射学发现；随后对 Pa 组和 Pb 组之间具有统计学意义的放射学发现进行了重新评估。计算了每个显著发现的灵敏度和特异性。采用卡方检验比较 P 组和 PP 组的放射学发现。
在 PP 组中，73.7%的磨玻璃影（GGO）和 80%的双侧多发 GGO （p<0.001 和 p=0.25）。仅在 PP 组中观察到单侧单发 GGO。卡方检验显示，弥漫性 GGO、单侧多发 GGO、多发实变和双侧多发实变在 P 组中的发生率明显更高（p=0.001、0.01、0.003 和 0.003）。然而，PP 组中 GGO 边界不规则和单侧实变更为显著（p=0.01 和 0.003）。值得注意的是，网状扭曲和胸膜下间隙仅在 PP 组中被发现。
我们得出结论，RSNA 用于诊断 COVID-19 的标准不适用于创伤患者。临床症状也并不总是有用。单侧多发 GGO、弥漫性 GGO 和双侧多发实变的存在提示 COVID-19 的可能性分别为 88%、97.62%和 77.7%。
