Halldorsson Kolbeinn, Nummela Mari, Thorisdottir Sigurveig, Oladottir Gudrun, Koskinen Seppo
Department of Diagnostic Radiology, 59562Karolinska University Hospital, Stockholm, Sweden.
Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Acta Radiol. 2023 Feb;64(2):684-689. doi: 10.1177/02841851221094966. Epub 2022 May 3.
Patients with severe penetrating trauma may require emergency surgery on arrival, and postoperative computed tomography (CT) can reveal significant additional injuries.
To determine the utility of postoperative CT performed within 48 h of emergency surgery after penetrating trauma.
Trauma registry data were retrieved over a seven-year period at a single level 1 trauma center. All patients aged ≥17 years, admitted with penetrating injury, who underwent urgent surgery and postoperative CT imaging within 48 h, were included. Pre- and intraoperative medical records were compared to CT findings. Age, sex, Injury Severity Score (ISS), New Injury Severity Score (NISS), 30-day mortality, injury mechanism, surgical intervention, and intensive care unit length of stay were extracted.
Out of 1262 patients, 38 fulfilled the study criteria (36 men [94.7%], 2 women [5.3%]; mean age = 31.5 years. Stab wound (SW) was the most common injury mechanism (26/38, 68.4%) followed by gunshot wound (GSW; 10/38, 26.3%). Patients with GSWs were more severely injured than SW victims (median NISS = 34 [range = 3-75]; for GSWs = 34; for SWs = 26; = 0.045). Out of 38 patients, 20 (52.6%) had additional findings at postoperative CT. Six patients (15.8%) had unidentified or underestimated findings at CT that were severe enough to warrant additional surgery or angiography.
Postoperative CT imaging after emergency surgery in penetrating trauma is an important tool in evaluating the injury panorama. Out of 38 patients, 6 (15.8%) had findings at postoperative CT that warranted additional surgical or angiographic intervention.
严重穿透性创伤患者可能在到达时就需要进行急诊手术，术后计算机断层扫描（CT）可发现其他严重损伤。
确定穿透性创伤急诊手术后48小时内进行术后CT的效用。
在一个一级创伤中心检索了七年期间的创伤登记数据。纳入所有年龄≥17岁、因穿透性损伤入院、在48小时内接受紧急手术和术后CT成像的患者。将术前和术中病历与CT检查结果进行比较。提取年龄、性别、损伤严重程度评分（ISS）、新损伤严重程度评分（NISS）、30天死亡率、损伤机制、手术干预和重症监护病房住院时间。
在1262例患者中，38例符合研究标准（36例男性[94.7%]，2例女性[5.3%]；平均年龄 = 31.5岁）。刺伤（SW）是最常见的损伤机制（26/38，68.4%），其次是枪伤（GSW；10/38，26.3%）。枪伤患者比刺伤受害者受伤更严重（NISS中位数 = 34[范围 = 3 - 75]；枪伤患者为34；刺伤患者为26；P = 0.045）。在38例患者中，20例（52.6%）术后CT有其他发现。6例患者（15.8%）在CT检查时有未识别或低估的发现，严重程度足以需要额外的手术或血管造影。
穿透性创伤急诊手术后的CT成像在评估损伤全貌方面是一项重要工具。在38例患者中，6例（15.8%）术后CT检查结果需要额外的手术或血管造影干预。
