Steele M T, Tran L V, Watson W A, Muelleman R L
Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City School of Medicine, 64108, USA.
Am J Emerg Med. 1998 Nov;16(7):627-30. doi: 10.1016/s0735-6757(98)90161-9.
A convenience sample of 164 adult patients with 185 glass-caused wounds who presented to an emergency department (ED) and consented to a radiograph was prospectively studied. The purpose was to determine the characteristics of wounds at high risk for foreign body (FB) and the predictive value of patient FB sensation and probing wound exploration for FB retention. Retained glass was located in 28 (15%) wounds. Motor vehicle as a mechanism of injury (P=.003), head as a location (P=.035), and puncture as wound type (P=.002) were more likely to be associated with retained FBs (chi2 analysis). Patients with wounds with glass were more likely to have a positive perception of a foreign body (41%) than those with no glass (17%) (P=.005). The positive predictive value of patient perception was 31%; negative predictive value was 89%. In five cases, wound exploration was negative and subsequent radiograph was positive for FB. In one of these cases, a 4-mm glass FB was removed; in the other four, no FB was found. In conclusion, head wounds resulting from motor vehicle accidents or puncture wounds are more likely to harbor retained glass FBs. Patients with glass FB in wounds are more likely to have a positive perception of FB; however, a positive perception has a low predictive value of glass FB. In this series, a negative wound exploration made the presence of retained FB greater than 2 mm less likely but did not rule out the presence of retained glass.
前瞻性研究了164例成年患者的185处玻璃致伤伤口，这些患者前往急诊科就诊并同意进行X光检查。目的是确定有异物（FB）高风险伤口的特征，以及患者对FB的感觉和伤口探查对FB存留的预测价值。28处（15%）伤口中发现有存留玻璃。损伤机制为机动车（P = 0.003）、损伤部位为头部（P = 0.035）以及伤口类型为穿刺伤（P = 0.002）更有可能与存留FB相关（χ²分析）。有玻璃伤口的患者比无玻璃伤口的患者更有可能对异物有阳性感觉（41%对17%）（P = 0.005）。患者感觉的阳性预测值为31%；阴性预测值为89%。在5例病例中，伤口探查为阴性，但随后的X光检查显示FB为阳性。其中1例取出了一块4毫米的玻璃FB；另外4例未发现FB。总之，机动车事故导致的头部伤口或穿刺伤更有可能存留玻璃FB。伤口中有玻璃FB的患者更有可能对FB有阳性感觉；然而，阳性感觉对玻璃FB的预测价值较低。在本系列研究中，伤口探查阴性使存留FB大于2毫米的可能性降低，但不能排除存留玻璃的存在。
