The Use of Delayed Computerized Tomography in the Evaluation of Blunt Abdominal Trauma: A Preliminary Report
The Use of Delayed Computerized Tomography in the Evaluation of Blunt Abdominal Trauma: A Preliminary Report
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延迟计算机断层扫描在腹部钝性损伤评估中的应用：初步报告
DOI：
10.1177/000313489906500418
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Wayne E. Silva
中科院分区：
文献类型：
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作者：
Andrew C. Stanley;Frank Vittemberger;Lena M. Napolitano;Kathleen P. O'Hara;Karen Mcginnis;Diane Lockhart;Wayne E. Silva
本研究的目的是分析腹部计算机断层扫描 (CT) 成像在可能患有腹部钝性创伤的患者中的应用。对 1 年期间（1993 年至 1994 年）的所有创伤患者进行了回顾性分析，其中 52 名患者采用前瞻性研究方案，使用连续腹部检查和血细胞比容 (Hcts) 代替腹部 CT 来评估腹部钝性创伤。在这一年的时间里，紧急腹部 CT 被用作评估 813 名患者腹部钝性损伤的初始诊断测试。其中 379 名 (46.6%) 患者进行了 CT 检查，这些患者到达时血流动力学稳定（入院收缩压 ≥ 90），格拉斯哥昏迷量表 > 13，入院 Hct ≥ 35，因为分散注意力的损伤、可能的脑外伤或酒精/药物使用可能导致腹部体检不可靠。只有 47 例 CT 扫描（12.4%）呈阳性，三名患者（0.8%）需要剖腹手术。为了更有效地使用腹部 CT，我们对 52 名可能患有腹部闭合性损伤、入院收缩压≥ 90、Hct ≥ 35、格拉斯哥昏迷量表 > 13、入院时腹部检查正常的患者进行了一项前瞻性研究。对这些患者进行连续 24 小时内每 6 小时一次的腹部检查和 Hct 随访，并在适用时进行延迟 CT 检查。 7名患者（13.5%）进行了CT检查，以评估Hct下降或腹部检查异常；腹部损伤均为阴性。使用连续腹部检查、Hct 和延迟腹部 CT 成像的方案可能有助于选择患者，以减少在评估腹部钝性损伤时获得的大量常规腹部 CT 阴性结果。
This purpose of this study was to analyze the use of abdominal computed tomography (CT) imaging in patients with possible blunt abdominal trauma. A retrospective analysis of all trauma patients over a 1-year period (1993–1994) was conducted, with prospective study protocol in 52 patients using serial abdominal exam and hematocrits (Hcts) instead of abdominal CT for evaluation of blunt abdominal trauma. Urgent abdominal CT was used as the initial diagnostic test for evaluation of blunt abdominal trauma in 813 patients over this 1-year period. CT was obtained in 379 (46.6%) of these patients who arrived hemodynamically stable (admission systolic blood pressure ≥ 90), had a Glasgow Coma Scale > 13, and had admission Hct ≥ 35 because of distracting injuries, possible traumatic brain injury, or alcohol/drug use, which might render the abdominal physical exam unreliable. Only 47 CT scans (12.4%) were positive, and three patients (0.8%) required laparotomy. In an effort to more efficiently use abdominal CT, we performed a prospective study in 52 patients with possible blunt abdominal trauma, admission systolic blood pressure ≥ 90, Hct ≥ 35, Glasgow Coma Scale > 13, and a normal abdominal exam on admission. These patients were followed with serial abdominal examinations and Hcts every 6 hours for 24 hours, and delayed CT, when applicable. CT was obtained in seven patients (13.5%) for evaluation of fall in Hct or abnormal abdominal examination; all were negative for abdominal injury. A protocol using serial abdominal exams, Hcts, and delayed abdominal CT imaging may be useful in select patients to decrease the high number of negative routine abdominal CTs that are obtained in the evaluation of blunt abdominal trauma.