四肢骨折是最常被漏诊的损伤：一项针对重症监护病房收治的多发伤患者的前瞻性队列研究。
Extremity Fractures as the Most Common Missed Injuries: A Prospective Cohort in Intensive Care Unit Admitted Multiple Trauma Patients.
作者信息
Bahramian Mehran, Shahbazi Parmida, Hemmati Nima, Mohebzadeh Parisa, Najafi Arvin
机构信息
Department of Emergency Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran.
Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran.
出版信息
Indian J Crit Care Med. 2023 Mar;27(3):201-204. doi: 10.5005/jp-journals-10071-24426.
BACKGROUND
Although an intensive care unit (ICU) admission is a risk factor for missed injury, there has been some disagreement on whether missed injuries in trauma ICU patients have a longer length of stay (LOS). With this in mind, these patients' frequency of missed injuries and related factors were investigated.
MATERIALS AND METHODS
This was a prospective cohort study on multiple trauma injury patients in a tertiary referral trauma center's trauma intensive care unit (TICU) from March 2020 to March 2021. A tertiary survey was conducted in the TICU by attending physicians to find the types I and II missed injuries (any injury discovered after primary and secondary surveys during the hospital stay). A logistic regression model was designed for predictors of missed injuries in ICU-admitted multiple trauma patients.
RESULTS
Out of 290 study participants, 1,430 injuries were found, and of those injuries, 74 cases (25.5%) had missed injuries. In other words, there were 103 missed injuries, resulting in a missed injury detection rate of 7.2%. The most frequently missed injuries (43.4%) were concluded as extremities fractures. The regression model showed that the patients with missed injuries are prone to longer TICU LOS [odds ratio (OR) = 1.15; = 0.033], and cases who underwent a computed tomography (CT) scan are less likely to have missed injuries (OR = 0.04; < 0.001). The abbreviated injury scale (AIS) range was 1-3 in missed injuries.
CONCLUSION
Our research underlines the importance of finding missed injuries and the necessity of CT scan to decrease them. In teaching centers, life-threatening injuries decrease with increasing visits and examination times. Although these missed injuries do not increase mortality, they cause longer TICU LOS and costs.
HOW TO CITE THIS ARTICLE
Bahramian M, Shahbazi P, Hemmati N, Mohebzadeh P, Najafi A. Extremity Fractures as the Most Common Missed Injuries: A Prospective Cohort in Intensive Care Unit Admitted Multiple Trauma Patients. Indian J Crit Care Med 2023;27(3):201-204.
背景
尽管入住重症监护病房（ICU）是漏诊损伤的一个风险因素，但对于创伤ICU患者的漏诊损伤是否会导致更长的住院时间（LOS），一直存在一些分歧。考虑到这一点，我们对这些患者的漏诊损伤频率及相关因素进行了调查。
材料与方法
这是一项对2020年3月至2021年3月在一家三级转诊创伤中心的创伤重症监护病房（TICU）的多发伤患者进行的前瞻性队列研究。由主治医生在TICU进行三级检查，以发现I型和II型漏诊损伤（在住院期间的初次和二次检查后发现的任何损伤）。针对入住ICU的多发伤患者漏诊损伤的预测因素设计了一个逻辑回归模型。
结果
在290名研究参与者中，共发现1430处损伤，其中74例（25.5%）存在漏诊损伤。也就是说，共有103处漏诊损伤，漏诊损伤检出率为7.2%。最常漏诊的损伤（43.4%）为四肢骨折。回归模型显示，存在漏诊损伤的患者更容易有更长的TICU住院时间[比值比（OR）=1.15；P = 0.033]，而接受计算机断层扫描（CT）的患者漏诊损伤的可能性较小（OR = 0.04；P < 0.001）。漏诊损伤的简明损伤定级（AIS）范围为1 - 3级。
结论
我们的研究强调了发现漏诊损伤的重要性以及进行CT扫描以减少漏诊损伤的必要性。在教学中心，随着就诊次数和检查时间的增加，危及生命的损伤会减少。虽然这些漏诊损伤不会增加死亡率，但会导致更长的TICU住院时间和费用。
如何引用本文
Bahramian M, Shahbazi P, Hemmati N, Mohebzadeh P, Najafi A. Extremity Fractures as the Most Common Missed Injuries: A Prospective Cohort in Intensive Care Unit Admitted Multiple Trauma Patients. Indian J Crit Care Med 2023;27(3):201 - 204.
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