Abdel Hamid Mohamed A, Abd-erRazik Mohammad A, Nagy Mostafa, El-Shinawi Mohamed, Hirshon Jon M, El-Setouhy Maged
Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
Afr J Emerg Med. 2024 Jun;14(2):96-99. doi: 10.1016/j.afjem.2023.11.006. Epub 2024 Apr 30.
Trauma is a significant cause of mortality, especially among individuals aged between 15 and 44 years, with a substantial burden falling on economically active populations. Low- and middle-income countries (LMICs) bear the burden of trauma-related deaths, accounting for over 90 % globally. In Egypt, trauma rates are increasing, primarily due to road traffic crashes (RTC), affecting males disproportionately. Blunt abdominal trauma, often caused by RTC, can lead to missed intra-abdominal injuries (IAIs) due to atypical symptoms. Computed Tomography (CT) offers high sensitivity and specificity in detecting IAIs, but concerns about cost and radiation exposure exist.
This study investigates the roles of Focused Assessment with Sonography for Trauma (FAST) and CT in managing blunt abdominal trauma. A retrospective cohort study was conducted on hemodynamically stable patients. Data included patient demographics, trauma details, healthcare decisions, costs, and outcomes.
Computed tomography significantly reduced unnecessary laparotomies (12.3% vs. 24.8 %, = 0.001), shortened hospital stays (4.83±0.71 days vs. 6.15±1.28 days, = 0.005), and reduced ICU admissions (8 vs. 32, = 0.023) compared to FAST alone. Overall costs were lower in the CT & FAST Group ($2055.95 vs. $3488.7, = 0.0001), with no significant difference in missed IAIs.
This study highlights the limitations of relying solely on FAST for IAIs and underscores the value of CT in guiding healthcare decisions. Incorporating CT led to reduced negative laparotomies, shorter hospital stays, and fewer ICU admissions. While CT incurs initial costs, its long-term benefits outweigh expenditures, particularly in LMICs. This study provides insights into optimizing diagnostic approaches for blunt abdominal trauma in low-resource settings.
创伤是导致死亡的重要原因，尤其是在15至44岁的人群中，给经济活跃人口带来了沉重负担。低收入和中等收入国家（LMICs）承担着与创伤相关的死亡负担，占全球此类死亡人数的90%以上。在埃及，创伤发生率正在上升，主要原因是道路交通事故（RTC），男性受影响的比例过高。钝性腹部创伤通常由道路交通事故引起，由于症状不典型，可能导致腹内损伤（IAIs）漏诊。计算机断层扫描（CT）在检测腹内损伤方面具有高灵敏度和特异性，但存在成本和辐射暴露方面的担忧。
本研究调查了创伤超声重点评估（FAST）和CT在钝性腹部创伤管理中的作用。对血流动力学稳定的患者进行了一项回顾性队列研究。数据包括患者人口统计学信息、创伤细节、医疗决策、成本和结果。
与单独使用FAST相比，计算机断层扫描显著减少了不必要的剖腹手术（12.3%对24.8%，P = 0.001），缩短了住院时间（4.83±0.71天对6.15±1.28天，P = 0.005），并减少了重症监护病房（ICU）入院人数（8例对32例，P = 0.023）。CT与FAST联合组的总体成本较低（2055.95美元对3488.7美元，P = 0.0001），漏诊腹内损伤方面无显著差异。
本研究强调了仅依靠FAST诊断腹内损伤的局限性，并强调了CT在指导医疗决策方面的价值。采用CT可减少阴性剖腹手术、缩短住院时间并减少ICU入院人数。虽然CT会产生初始成本，但其长期效益超过支出，特别是在低收入和中等收入国家。本研究为在资源有限的环境中优化钝性腹部创伤的诊断方法提供了见解。
