Are We Missing Traumatic Bowel and Mesenteric Injuries?
Are We Missing Traumatic Bowel and Mesenteric Injuries?
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DOI：
10.1016/j.carj.2015.11.006
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发表时间：
2016-11-01
期刊：
影响因子：
3.1
通讯作者：
Nicolaou, Savvas
中科院分区：
文献类型：
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作者：
Landry, Bret A.;Patlas, Michael N.;Nicolaou, Savvas
目的：创伤性肠及肠系膜损伤（TBMI）虽然并不常见，但如果不能及时发现和治疗，可能会致命。我们研究的目的是评估64层多排螺旋计算机断层扫描（MDCT）在我们的一级创伤中心对TBMI检测的诊断准确性。
方法：我们利用医院的创伤登记系统，确定2006年1月1日至2013年6月30日期间诊断为TBMI的患者。只有在就诊时进行了64层MDCT扫描且随后接受了剖腹手术或腹腔镜手术的患者才被纳入研究队列。以手术结果作为金标准，分析前瞻性放射学报告的准确性。
结果：在我们医院就诊的4781例创伤患者中，44例（0.92%）经手术证实为TBMI。44例中有22例因术前未进行MDCT而被排除。研究队列包括14名男性和8名女性，中位年龄为41.5岁，中位损伤严重程度评分为27分。22例患者中共有17例为钝性创伤，5例为穿透性创伤。22例患者中有14例术前影像学诊断正确。放射学报告的总体敏感度为63.6%（95%置信区间[CI]：41% - 82%），特异度为79.6%（95%CI：67% - 89%），阳性预测值为53.9%（95%CI：33% - 73%），阴性预测值为85.5%（95%CI：73% - 94%）。准确率计算为75.3%。然而，只有59%（17例中的10例）的钝性创伤患者术前诊断正确。对结果的回顾表明，大多数漏诊的钝性TBMI患者（7例中的5例）仅表现出间接损伤征象。
结论：64层MDCT对创伤患者TBMI的检测可以改进，尤其是在钝性创伤患者中。该人群中出现漏诊病例是因为尽管存在间接影像学征象，但未考虑TBMI的可能性。尽管CT技术有所进步且64层MDCT广泛应用，但TBMI的前瞻性诊断仍然具有挑战性。
Purpose: Traumatic bowel and mesenteric injury (TBMI), although an uncommon entity, can be lethal if not detected and treated in a timely manner. The purpose of our study was to evaluate the diagnostic accuracy of 64-slice multidetector computed tomography (MDCT) for the detection of TBMI in patients at our level 1 trauma centre.Methods: We used our hospital's trauma registry to identify patients with a diagnosis of TBMI from January 1, 2006, to June 30, 2013. Only patients who had a 64-slice MDCT scan at presentation and subsequently underwent laparotomy or laparoscopy were included in the study cohort. Using the surgical findings as the gold standard, the accuracy of prospective radiology reports was analyzed.Results: Of the 4781 trauma patients who presented to our institution, 44 (0.92%) had surgically proven TBMI. Twenty-two of 44 were excluded as they did not have MDCT before surgery. The study cohort consisted of 14 males and 8 females with a median age of 41.5 years and a median injury severity score of 27. In total 17 of 22 had blunt trauma and 5 of 22 had penetrating injury. A correct preoperative imaging diagnosis of TBMI was made in 14 of 22 of patients. The overall sensitivity of the radiology reports was 63.6% (95% confidence interval [CI]: 41%-82%), specificity was 79.6% (95% CI: 67%-89%), PPV was 53.9% (95% CI: 33%-73%), and the NPV was 85.5% (95% CI: 73%-94%). Accuracy was calculated at 75.3%. However, only 59% (10 of 17) of patients with blunt injury had a correct preoperative diagnosis. Review of the findings demonstrated that majority of patients with missed blunt TBMI (5 of 7) demonstrated only indirect signs of injury.Conclusion: The detection of TBMI in trauma patients on 64-slice MDCT can be improved, especially in patients presenting with blunt injury. Missed cases in this population occurred because the possibility of TBMI was not considered despite the presence of indirect imaging signs. The prospective diagnosis of TBMI remains challenging despite advances in CT technology and widespread use of 64-slice MDCT.