Chung Jae Sik, An Sanghyun, Gong Seong Chan, Jung Pil Young
Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
Diagnostics (Basel). 2023 May 27;13(11):1879. doi: 10.3390/diagnostics13111879.
(1) Background: Skeletal injuries may be missed in patients presenting multiple traumas during initial assessment. A whole-body bone scan (WBBS) may aid the detection of missed skeletal injuries, but the current level of research in this regard is insufficient. Thus, this study aimed to investigate whether a WBBS is useful for the detection of missed skeletal injuries in patients with multiple traumas. (2) Methods: This retrospective, single-region, trauma center study was conducted at a tertiary referral center from January 2015 to May 2019. The rate of missed skeletal injuries detected via WBBSs was evaluated, and factors that could influence the outcome were analyzed and divided into missed and not-missed groups. (3) Results: A total of 1658 patients with multiple traumas who underwent WBBSs were reviewed. In the missed group, the percentage of cases with an Injury Severity Score (ISS) ≥ 16 was higher than the not-missed group (74.66% vs. 45.50%). The rate of admission route through surgery and embolization was high in the missed group. Moreover, the proportion of patients that experienced shock in the missed group was higher than that in the not-missed group (19.86% vs. 3.51%). In univariate analysis, ISS ≥ 16, admission route through surgery and embolization, orthopedic surgery involvement, and shock were related to missed skeletal injuries. ISS ≥ 16 was determined to be statistically significant in multivariate analysis. Additionally, a nomogram was constructed based on multivariable analysis. (4) Conclusions: Missed skeletal injuries were significantly associated with several statistical factors, and a WBBS can be used as a screening method to detect missed skeletal injuries in patients with multiple blunt traumas.
（1）背景：在初次评估时，多发伤患者可能会漏诊骨骼损伤。全身骨扫描（WBBS）可能有助于发现漏诊的骨骼损伤，但目前这方面的研究水平不足。因此，本研究旨在调查WBBS对多发伤患者漏诊骨骼损伤的检测是否有用。（2）方法：本回顾性、单区域创伤中心研究于2015年1月至2019年5月在一家三级转诊中心进行。评估通过WBBS检测到的漏诊骨骼损伤率，并分析可能影响结果的因素，将其分为漏诊组和未漏诊组。（3）结果：共回顾了1658例接受WBBS的多发伤患者。在漏诊组中，损伤严重程度评分（ISS）≥16的病例百分比高于未漏诊组（74.66%对45.50%）。漏诊组通过手术和栓塞的入院途径发生率较高。此外,漏诊组经历休克的患者比例高于未漏诊组（19.86%对3.51%）。单因素分析中，ISS≥16、通过手术和栓塞的入院途径、骨科手术参与情况和休克与漏诊骨骼损伤有关。多因素分析中，ISS≥16具有统计学意义。此外，基于多变量分析构建了列线图。（4）结论：漏诊骨骼损伤与几个统计学因素显著相关，WBBS可作为一种筛查方法，用于检测多发钝性伤患者的漏诊骨骼损伤。
