Navarrete-Navarro P, Vázquez G, Bosch J M, Fernández E, Rivera R, Carazo E
UCI de Trauma, Hospital de Traumatología, Granada, Spain.
Intensive Care Med. 1996 Mar;22(3):208-12. doi: 10.1007/BF01712238.
To compare contrast computed tomography (CT) for evaluating abdominal and vascular chest injuries after emergency room resuscitation with multidisciplinary management based on bedside procedure (BP), e.g., peritoneal lavage, abdomen ultrasonography urography and, if indicated, CT and/or aortography or transesophageal echocardiography.
Randomized study.
Emergency, critical care and radiology departments in a trauma center.
The study was performed in 103 severe blunt trauma patients with a revised trauma index < 8, admitted over a 16 month period and divided into group (G1, n = 52, CT management) and group 2 (G2, n = 51, BP management).
A relative direct cost scale used in our trauma center was applied, and cost units (U) were assigned to each diagnostic test for cost-minimization analysis (abdomen ultrasonograph = 7.5 U, peritoneal lavage = 8 U, urography = 9 U, computed tomography = 9 U, transesophageal echocardiography = 13.5 U, and aortography = 15 U). One unit is approximately equivalent to $43.7.
Injury severity score (ISS) was 31.7 +/- 15.4 in G1 and 33.8 +/- 18.3 in G2. Sensitivity for CT was 90.4% (G1) vs 72.5% for BP (G2) in abdomen (P < 0.01) and 60% in chest for evaluating mediastinal hematoma etiology (G1). As Table 2 shows, G1 needed 59 tests for evaluating injuries (1.1 +/- 0.3 tests patient) while G2 required 81 tests (1.68 +/- 0.8 tests/patient) (P < 0.01). The total relative cost was 538 U for G1, 7.04 +/- 2.2 U cost/injury and 10.3 +/- 3.3 U/evaluation of trauma vs 698 U for G2, 9.84 +/- 5.03 U cost/injury and 13.68 +/- 8.5 U/evaluation (P < 0.05).
This cost-minimization study suggests that CT is a more cost-effective method for the post-emergency room resuscitation evaluation of severe abdominal blunt trauma than the multidisciplinary BP. Chest CT is a screening method for mediastinal hematoma but not for etiology.
比较对比计算机断层扫描（CT）与基于床旁操作（BP）的多学科管理（如腹腔灌洗、腹部超声造影，必要时进行CT和/或主动脉造影或经食管超声心动图）用于评估急诊室复苏后腹部和血管性胸部损伤的效果。
随机研究。
创伤中心的急诊科、重症监护科和放射科。
本研究纳入103例创伤指数修正值<8的严重钝性创伤患者，这些患者在16个月期间入院，并分为两组（G1组，n = 52，CT管理）和G2组（n = 51，BP管理）。
应用我们创伤中心使用的相对直接成本量表，并为每项诊断检查分配成本单位（U）以进行成本最小化分析（腹部超声检查 = 7.5 U，腹腔灌洗 = 8 U，尿路造影 = 9 U，计算机断层扫描 = 9 U，经食管超声心动图 = 13.5 U，主动脉造影 = 15 U）。一个单位约相当于43.7美元。
G1组的损伤严重度评分（ISS）为31.7±15.4，G2组为33.8±18.3。在评估腹部损伤时，CT的敏感性为90.4%（G1组），而BP为72.5%（G2组）（P<0.01），在评估纵隔血肿病因时，胸部CT的敏感性为60%（G1组）。如表2所示，G1组评估损伤需要59项检查（1.1±0.3项检查/患者），而G2组需要81项检查（1.68±0.8项检查/患者）（P<0.01）。G1组的总相对成本为538 U，每项损伤的成本为7.04±2.2 U，每次创伤评估的成本为10.3±3.3 U；而G2组分别为698 U、9.84±5.03 U和13.68±8.5 U（P<0.05）。
这项成本最小化研究表明，对于严重腹部钝性创伤的急诊室复苏后评估，CT比多学科BP方法更具成本效益。胸部CT是纵隔血肿的筛查方法，但不是病因诊断方法。
