全身创伤 CT 的使用应基于损伤机制：三级创伤中心 3920 例患者的风险分析。

The use of whole-body trauma CT should be based on mechanism of injury: A risk analysis of 3920 patients at a tertiary trauma centre.

机构信息

Department of Radiology, Alfred Health, Melbourne, Australia. Electronic address: https://twitter.com/https//twitter.comSalamfindalky.

Department of Radiology, Alfred Health, Melbourne, Australia. Electronic address: https://twitter.com/https//twitter.comAdilFZia.

出版信息

Injury. 2023 Jul;54(7):110828. doi: 10.1016/j.injury.2023.05.059. Epub 2023 May 20.

DOI:10.1016/j.injury.2023.05.059

PMID:37225543

Abstract

BACKGROUND

Mechanism of injury (MOI) plays a significant role in a decision to perform whole-body computed tomography (CT) imaging for trauma patients. Various mechanisms have unique patterns of injury and therefore form an important variable in decision making.

METHODS

Retrospective cohort study including all patients >18 years old who received a whole-body CT scan between 1 January 2019 and 19 February 2020. The outcomes were divided into CT 'positive' if any internal injuries were detected and CT 'negative' if no internal injuries were detected. The MOI, vital sign parameters, and other relevant clinical examination findings at presentation were recorded.

RESULTS

3920 patients met the inclusion criteria, of which 1591 (40.6%) had a positive CT. The most common MOI was fall from standing height (FFSH), accounting for 23.0%, followed by motor vehicle accident (MVA), accounting for 22.4%. Covariates significantly associated with a positive CT included age, MVA >60 km/h, motor bike, bicycle, or pedestrian accident >30 km/h, prolonged extrication >30 min, fall from height above standing, penetrating chest or abdominal injury, as well as hypotension, neurological deficit, or hypoxia on arrival. FFSH was shown to reduce the risk of a positive CT overall, however, sub-analysis of FFSH in patients >65 years showed a significant association with a positive CT (OR 2.34, p < 0.001) compared to <65 years.

CONCLUSIONS

Pre-arrival information including MOI and vital signs have significant impact on identifying subsequent injuries with CT imaging. In high energy trauma, we should consider the need for whole-body CT based on MOI alone regardless of the clinical examination findings. However, for low-energy trauma, including FFSH, in the absence of clinical examination findings which support an internal injury, a screening whole-body CT is unlikely to yield a positive result, particularly in the age group <65yo.

摘要

背景

受伤机制（MOI）在决定对创伤患者进行全身计算机断层扫描（CT）检查方面起着重要作用。各种机制具有独特的损伤模式，因此是决策中的一个重要变量。

方法

这是一项回顾性队列研究，纳入了 2019 年 1 月 1 日至 2020 年 2 月 19 日期间接受全身 CT 扫描的年龄>18 岁的所有患者。如果发现任何内部损伤，则将结果分为 CT“阳性”，如果未发现内部损伤，则将结果分为 CT“阴性”。记录受伤机制、生命体征参数以及就诊时的其他相关临床检查结果。

结果

共纳入 3920 例患者，其中 1591 例（40.6%）CT 阳性。最常见的受伤机制是从站立高度坠落（FFSH），占 23.0%，其次是机动车事故（MVA），占 22.4%。与 CT 阳性显著相关的协变量包括年龄、MVA>60km/h、摩托车、自行车或行人事故>30km/h、解救时间延长>30min、高于站立的高度坠落、穿透性胸部或腹部损伤，以及到达时低血压、神经功能缺损或缺氧。FFSH 总体上降低了 CT 阳性的风险，但>65 岁的 FFSH 亚组分析显示与 CT 阳性有显著关联（OR 2.34，p<0.001），而<65 岁的则没有。

结论

到达前的信息，包括受伤机制和生命体征，对识别 CT 成像后的损伤具有重要意义。在高能量创伤中，我们应根据受伤机制单独考虑是否需要进行全身 CT 检查，而无需考虑临床检查结果。然而，对于低能量创伤，包括 FFSH，如果没有支持内部损伤的临床检查结果，全身 CT 筛查不太可能产生阳性结果，尤其是在<65 岁的年龄组。