Meyer D M, Thal E R, Coln D, Weigelt J A
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-8879.
Ann Surg. 1993 Mar;217(3):272-6. doi: 10.1097/00000658-199303000-00009.
This study determined the sensitivity, specificity, and accuracy of CT in pediatric patients with blunt trauma. Correlation of the CT-identified injuries and intraoperative findings with comparison to the results of DPL was performed.
Clinical evaluation frequently is unreliable in determining the presence of intra-abdominal injury in children with blunt trauma. Peritoneal lavage has been used to establish the need for operative intervention and has been found to be safe, efficient, and reliable (98%). In many institutions, abdominal CT scans are used to evaluate these children. Because most reports involve nonoperative management, operative confirmation of CT-identified injuries is available only for those children in whom nonoperative treatment is unsuccessful.
Sixty children sustaining blunt abdominal trauma were included in the study. CT scans with both oral and IV contrast were performed before open lavage, and positive results were confirmed by operation in 18 patients.
CT had a sensitivity of 67%, however, only 60% of the actual organ injuries were identified by the scan. In contrast, DPL has a sensitivity of 94%. Both studies were equally specific (100%). DPL was also more accurate, 98% as compared with 89% for CT.
Although the abdominal CT scan is useful in evaluating children with blunt abdominal trauma, a number of significant injuries were missed. Based on the low sensitivity of the CT, the authors suggest diagnostic peritoneal lavage may offer advantages over CT as the initial study in the evaluation of children with blunt abdominal trauma.
本研究确定了CT在小儿钝性创伤患者中的敏感性、特异性和准确性。将CT识别的损伤及术中发现与腹腔灌洗结果进行了相关性比较。
在判定钝性创伤患儿是否存在腹内损伤时，临床评估常常不可靠。腹腔灌洗已被用于确定是否需要进行手术干预，并且已被证明是安全、有效且可靠的（98%）。在许多机构中，腹部CT扫描被用于评估这些患儿。由于大多数报告涉及非手术治疗，只有那些非手术治疗失败的患儿，才能通过手术证实CT识别的损伤。
60例腹部钝性创伤患儿纳入本研究。在开放灌洗前进行了口服和静脉造影的CT扫描，18例患者通过手术证实结果为阳性。
CT的敏感性为67%，然而，扫描仅识别出60%的实际器官损伤。相比之下，腹腔灌洗的敏感性为94%。两项研究的特异性均为100%。腹腔灌洗也更准确，为98%，而CT为89%。
尽管腹部CT扫描在评估腹部钝性创伤患儿时有用，但仍有许多严重损伤被漏诊。基于CT的低敏感性，作者认为诊断性腹腔灌洗作为评估腹部钝性创伤患儿的初始检查，可能比CT更具优势。
