Giangrosso Gerard V, Bayliss Ty, Rahimpour Armein, Murphy Abigail, Ray Peter, Denning David, Barry Rahman
General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Plastic Surgery, King's Daughters Medical Center, Ashland, USA.
Cureus. 2024 Jul 4;16(7):e63830. doi: 10.7759/cureus.63830. eCollection 2024 Jul.
This study aimed to evaluate the cost vs. benefits of the CT face imaging study in the trauma workup of those over the age of 65.
We performed a retrospective chart review of 169 trauma patients in our trauma database aged 65 years or older who underwent a CT of the head, a CT of the face, or a CT of the head and CT of the face that resulted in findings of a facial fracture from 2017-2022. Injuries and the treatment they received were documented. If a patient underwent both a CT of the face and a CT of the head, then the author first viewed the CT of the head, documented any injury, and then recorded treatment based on the CT of the head. The CT of the face was then viewed, injuries were recorded, and treatment based on the CT of the face was documented. Statistical analysis was then performed using the paired T-test, McNemar test, and number needed to harm analysis.
Of the 169 patients sampled, 159 underwent both CT of the head and the face. There were no patients who underwent a CT of the face exclusively, and only 10 patients underwent a CT of the head exclusively. Of the 159 that had both a CT of the head and the face, the average number of injuries noted on CT of the head + CT of the face vs. CT of the head was 2.42 vs. 1.36, P<.0.0001. The number needed to avoid missing a surgical facial fracture when only a CT of the head was obtained was 14.68.
The risks of missing a surgical facial fracture outweigh the monetary, radiation, and patient-desired necessity benefits of only performing a CT of the head. A CT of the face should be included in the trauma workup for those over the age of 65 when facial fractures are suspected.
本研究旨在评估65岁以上患者创伤检查中CT面部成像检查的成本与效益。
我们对2017年至2022年期间在我们创伤数据库中年龄在65岁及以上、接受过头部CT、面部CT或头部CT加面部CT检查且结果显示有面部骨折的169例创伤患者进行了回顾性病历审查。记录损伤情况及所接受的治疗。如果患者同时接受了面部CT和头部CT检查，作者首先查看头部CT，记录任何损伤情况，然后根据头部CT记录治疗情况。接着查看面部CT，记录损伤情况，并记录根据面部CT进行的治疗。然后使用配对t检验、McNemar检验和伤害所需人数分析进行统计分析。
在抽样的169例患者中，159例同时接受了头部和面部CT检查。没有患者仅接受面部CT检查，只有10例患者仅接受头部CT检查。在159例同时接受头部和面部CT检查的患者中，头部CT + 面部CT检查发现的平均损伤数量与仅头部CT检查发现的平均损伤数量分别为2.42和1.36，P <.0001。仅进行头部CT检查时，避免漏诊手术性面部骨折所需的人数为14.68。
漏诊手术性面部骨折的风险超过了仅进行头部CT检查在金钱、辐射和患者期望必要性方面的益处。当怀疑有面部骨折时，65岁以上患者的创伤检查应包括面部CT检查。
