Sweet Arthur A R, van Wolfswinkel Sophie L, Kobes Tim, Benders Kim E M, Houwert Roderick M, Leenen Luke P H, de Jong Pim A, Veldhuis Wouter B, Hietbrink Falco, van Baal Mark C P M
Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Eur J Trauma Emerg Surg. 2025 Jul 14;51(1):254. doi: 10.1007/s00068-025-02929-0.
This study evaluates the impact of chest radiography on acute interventions in the trauma bay.
This cross-sectional study was performed on trauma patients admitted to the University Medical Center Utrecht, a level-1 trauma center, during a one-year period. All adult (≥ 16 years) trauma patients who underwent chest radiography in the trauma bay and were subsequently admitted to the hospital were eligible. Patients with non-blunt trauma, initial primary survey in another center, or initial chest radiography obtained outside the shock room were excluded. Patients were categorized as hemodynamically and respiratory compromised or non-compromised patients, and based on symptoms of chest injuries. Descriptive analyses were used.
This study included 780 patients, with a median age of 51 years (IQR 32-68), and 66.2% were male. Comorbidities (ASA 3-4) were seen in 12.8% and the median ISS was 10 (IQR 5-18). There were 382 hemodynamically and respiratory non-compromised patients without symptoms of chest injuries, of whom 255 underwent a subsequent chest CT. No acute interventions were performed in these patients. In symptomatic but hemodynamically and respiratory non-compromised patients (n = 289) there were 15 (5.2%) non-urgent chest tube placements prior to CT. Among 109 hemodynamically or respiratory compromised patients there were 16 (14.7%) chest tube placements and five (4.6%) resuscitation surgeries prior to the chest CT.
Omission of chest radiography in hemodynamically and respiratory non-compromised trauma patients presenting in the trauma bay seems safe, provided that a chest CT is already indicated.
本研究评估胸部X线摄影对创伤急救室急性干预措施的影响。
本横断面研究针对在一年期间入住乌得勒支大学医学中心（一级创伤中心）的创伤患者进行。所有在创伤急救室接受胸部X线摄影并随后入院的成年（≥16岁）创伤患者均符合条件。排除非钝性创伤患者、在其他中心进行初始初级评估的患者或在休克室外进行初始胸部X线摄影的患者。根据胸部损伤症状，将患者分为血流动力学和呼吸功能受损或未受损患者，并进行描述性分析。
本研究纳入780例患者，中位年龄为51岁（四分位间距32 - 68岁），66.2%为男性。12.8%的患者有合并症（美国麻醉医师协会分级3 - 4级），中位损伤严重度评分（ISS）为10分（四分位间距5 - 18分）。有382例血流动力学和呼吸功能未受损且无胸部损伤症状的患者，其中255例随后接受了胸部CT检查。这些患者未进行急性干预措施。在有症状但血流动力学和呼吸功能未受损的患者（n = 289）中，有15例（5.2%）在CT检查前进行了非紧急胸腔闭式引流置管。在109例血流动力学或呼吸功能受损的患者中，有16例（14.7%）在胸部CT检查前进行了胸腔闭式引流置管，5例（4.6%）进行了复苏手术。
对于创伤急救室中血流动力学和呼吸功能未受损的创伤患者，若已表明需要进行胸部CT检查，省略胸部X线摄影似乎是安全的。
