From the Section of Interventional Radiology (I.D.d.O.S., A.S.), Department of Radiology and Biomedical Imaging (I.D.d.O.S., A.S., N.S., R.B., J.C., J.T., M.V.R.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520; Department of Clinical Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.C.); and Department of Radiology, University of Washington School of Medicine, Seattle, Wash (E.A.R.).
Radiographics. 2023 Sep;43(9):e230040. doi: 10.1148/rg.230040.
According to the Centers for Disease Control and Prevention, trauma is the leading cause of fatal injuries for Americans aged 1-44 years old and the fourth leading overall cause of death. Accurate and early diagnosis, including grading of solid organ injuries after blunt abdominal trauma (BAT), is crucial to guide management and improve outcomes. The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) is the most widely accepted BAT scoring system at CT both within the United States and internationally, and its uses include stratification of injury severity, thereby guiding management, and facilitation of clinical research, billing, and coding. Furthermore, this system also plays a role in the credentialing process for trauma centers in the United States. The newly revised 2018 OIS provides criteria for grading solid organ damage into three groups: imaging, operation, and pathology. The final grade is based on the highest of the three criteria. If multiple lower-grade (I or II) injuries are present in a single organ, one grade is advanced to grade III. The most substantial change in the revised 2018 AAST-OIS is incorporation of multidetector CT findings of vascular injury, including pseudoaneurysm and arteriovenous fistula. The authors outline the main revised aspects of grading organ injury using the AAST-OIS for the spleen, liver, and kidney after BAT, particularly the role of multidetector CT and alternative imaging in organ injury detection, the importance of vascular injuries in grade change, and the impact of these changes on patient management and in prediction of operative treatment success and in-hospital mortality. RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
根据疾病控制和预防中心的数据，创伤是导致 1-44 岁美国人致命伤害的主要原因，也是导致死亡的第四大主要原因。准确和早期的诊断，包括钝性腹部创伤（BAT）后实体器官损伤的分级，对于指导治疗和改善预后至关重要。美国外科创伤协会（AAST）器官损伤分级（OIS）是目前在美国和国际上 CT 诊断 BAT 最广泛接受的评分系统，其用途包括损伤严重程度的分层，从而指导治疗和临床研究、计费和编码。此外，该系统还在美国创伤中心的认证过程中发挥作用。新修订的 2018 年 OIS 为分级实体器官损伤提供了三种标准：影像学、手术和病理学。最终等级基于三个标准中的最高等级。如果单一器官存在多个较低等级（I 或 II）损伤，则将一个等级提升至 III 级。修订后的 2018 年 AAST-OIS 的最大变化是纳入了多排 CT 血管损伤的发现，包括假性动脉瘤和动静脉瘘。作者概述了使用 AAST-OIS 对 BAT 后脾、肝和肾的器官损伤进行分级的主要修订方面，特别是多排 CT 和替代成像在器官损伤检测中的作用、分级变化中血管损伤的重要性以及这些变化对患者管理和手术治疗成功率和住院死亡率的预测的影响。RSNA，2023 本文的测验问题可通过在线学习中心获得。
