From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias).
Department of Surgery, Boston Children's Hospital/Harvard Medical System, Boston, MA (Delaplain).
J Am Coll Surg. 2023 Dec 1;237(6):826-833. doi: 10.1097/XCS.0000000000000863. Epub 2023 Sep 13.
High-quality CT can exclude hollow viscus injury (HVI) in patients with abdominal seatbelt sign (SBS) but performs poorly at identifying HVI. Delay in diagnosis of HVI has significant consequences necessitating timely identification.
This multicenter, prospective observational study conducted at 9 trauma centers between August 2020 and October 2021 included adult trauma patients with abdominal SBS who underwent abdominal CT before surgery. HVI was determined intraoperatively and physiologic, examination, laboratory, and imaging findings were collected. Least absolute shrinkage and selection operator- and probit regression-selected predictor variables and coefficients were used to assign integer points for the HVI score. Validation was performed by comparing the area under receiver operating curves (AUROC).
Analysis included 473 in the development set and 203 in the validation set. The HVI score includes initial systolic blood pressure <110 mmHg, abdominal tenderness, guarding, and select abdominal CT findings. The derivation set has an AUROC of 0.96, and the validation set has an AUROC of 0.91. The HVI score ranges from 0 to 17 with score 0 to 5 having an HVI risk of 0.03% to 5.36%, 6 to 9 having a risk of 10.65% to 44.1%, and 10 to 17 having a risk of 58.59% to 99.72%.
This multicenter study developed and validated a novel HVI score incorporating readily available physiologic, examination, and CT findings to risk stratify patients with an abdominal SBS. The HVI score can be used to guide decisions regarding management of a patient with an abdominal SBS and suspected HVI.
高质量 CT 可排除腹部安全带征（SBS）患者的空腔脏器损伤（HVI），但在识别 HVI 方面效果不佳。HVI 的诊断延误会带来严重后果，因此需要及时识别。
这项多中心、前瞻性观察研究于 2020 年 8 月至 2021 年 10 月在 9 家创伤中心进行，纳入了接受手术前腹部 CT 检查的伴有腹部 SBS 的成年创伤患者。术中确定 HVI，并收集生理、检查、实验室和影像学发现。使用最小绝对收缩和选择算子-和概率回归选择预测变量和系数，为 HVI 评分分配整数点。通过比较接收者操作曲线（AUROC）下的面积来进行验证。
分析纳入了 473 例来自发展集和 203 例来自验证集的患者。HVI 评分包括初始收缩压<110mmHg、腹部压痛、肌卫和特定的腹部 CT 发现。推导集的 AUROC 为 0.96，验证集的 AUROC 为 0.91。HVI 评分范围为 0 至 17，评分 0 至 5 的 HVI 风险为 0.03%至 5.36%，评分 6 至 9 的风险为 10.65%至 44.1%，评分 10 至 17 的风险为 58.59%至 99.72%。
这项多中心研究开发并验证了一种新的 HVI 评分，该评分结合了易于获得的生理、检查和 CT 发现，用于对伴有腹部 SBS 和疑似 HVI 的患者进行风险分层。HVI 评分可用于指导对伴有腹部 SBS 和疑似 HVI 的患者的管理决策。
