Cohen Israel, Guranda Larisa, Ironi Avinoah, Naveh Lior, Tau Noam
Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel.
Eur J Radiol. 2022 Jun;151:110290. doi: 10.1016/j.ejrad.2022.110290. Epub 2022 Apr 4.
To assess the role of thoraco-abdominal computed tomography (CT) in patients with undifferentiated shock in the emergency department (ED). Secondary aim was to assess common etiologies for undifferentiated shock.
This was a single-center, retrospective study evaluating patients with undifferentiated shock who underwent a dedicated "shock protocol" CT in the ED. CT included a non-contrast thoraco-abdominal scan followed by arterial thoraco-abdominal and abdominal portal phases. Patients' clinical records, laboratory, imaging data and all-cause 90-days mortality were collected. Patients' shock category (i.e., distributive, cardiogenic, hypovolemic, obstructive, multifactorial, and unknown) and etiology for shock were retrospectively determined based on patients' medical records. Effect of CT on patients' diagnosis and management was assessed based on physicians' reports before and after CT.
Overall, 102 patients were scanned between December 2018 and December 2020. Distributive shock was the most prevalent type with 47.1% of all patients (48/102), followed by hypovolemic shock (17/102, 16.7%). Based on clinical data and CT reports, shock etiology was diagnosed for 89.2% (91/102) patients. Sepsis was the most common etiology in 50% of patients, followed by non-traumatic hemorrhage (15/102, 14.7%). Overall, 90-day mortality was 58.8%. Shock protocol CT led to change in differential diagnosis in 49% of patients and to change in management in 42.2%.
Contrast-enhanced shock protocol CT can help in shock differentiation, assessment of etiology and in management of patients presenting to the ED with undifferentiated shock.
评估胸腹计算机断层扫描（CT）在急诊科（ED）未分化休克患者中的作用。次要目的是评估未分化休克的常见病因。
这是一项单中心回顾性研究，评估在ED接受专门“休克方案”CT检查的未分化休克患者。CT包括非增强胸腹扫描，随后是动脉期胸腹扫描和腹部门静脉期扫描。收集患者的临床记录、实验室检查、影像数据和全因90天死亡率。根据患者的病历回顾性确定患者的休克类型（即分布性、心源性、低血容量性、梗阻性、多因素性和不明原因）和休克病因。根据医生在CT检查前后的报告评估CT对患者诊断和治疗的影响。
总体而言，2018年12月至2020年12月期间对102例患者进行了扫描。分布性休克是最常见的类型，占所有患者的47.1%（48/102），其次是低血容量性休克（17/102，16.7%）。根据临床数据和CT报告，89.2%（91/102）的患者诊断出休克病因。脓毒症是50%患者中最常见的病因，其次是非创伤性出血（15/102，14.7%）。总体而言，90天死亡率为58.8%。休克方案CT导致49%的患者鉴别诊断发生改变，42.2%的患者治疗发生改变。
对比增强休克方案CT有助于对ED中出现的未分化休克患者进行休克鉴别、病因评估和治疗。
