Clinical analysis of the utility of repeat computed tomographic scan before discharge in blunt hepatic injury
Clinical analysis of the utility of repeat computed tomographic scan before discharge in blunt hepatic injury
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DOI：
10.1097/00005373-199611000-00009
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发表时间：
1996-11-01
影响因子：
--
通讯作者：
Jacobs, L
中科院分区：
文献类型：
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作者：
Ciraulo, DL;Nikkanen, HE;Jacobs, L
目的：血流动力学稳定的钝性肝损伤的非手术治疗已成为一种可接受且安全的治疗方法。对这类患者损伤的监测成本较高。作为制定实践指南的前奏，对重复计算机断层扫描（CT）的效用进行了研究。
方法：对243例肝损伤进行了回顾性研究。回顾了95例接受非手术治疗且无持续输血需求患者的CT扫描结果，并根据美国创伤外科协会（AAST）肝损伤分级标准进行分级。患者根据损伤分级分组，分为两个亚组（进行1次CT扫描的患者与进行多次CT扫描的患者），并就若干生理和临床变量进行比较。
结果：统计分析显示，相同损伤分级的亚组之间无显著差异。亚组之间的住院时间也无显著差异。
结论：没有患者非手术治疗失败或因损伤死亡。对于Ⅲ级或更低级别肝损伤且临床稳定的患者，重复CT扫描的结果未改变出院的决定。
Objectives: Nonoperative management of hemodynamically stable blunt hepatic injury has emerged as an acceptable and safe treatment. Surveillance of this population's injuries is costly. As a prelude to establishing practice guidelines, the utility of repeat computed tomographic (CT) scans was investigated.Methods: A retrospective study was conducted on 243 hepatic injuries. The CT scans of 95 patients managed nonoperatively who did not have ongoing transfusion requirements were reviewed and graded according to the American Association for the Surgery of Trauma (AAST) hepatic injury scale, Patients were grouped according to injury grade, assigned to two subgroups (patients with one CT scan versus more than one CT scan) and compared with respect to several physiologic and clinical variables.Results: Statistical analysis revealed no significant difference between subgroups with the same grade of injury. No significant difference was demonstrated between subgroups' length of stay.Conclusions: No patients failed nonoperative treatment or succumbed to their injuries. Findings on repeat CT scan have not altered the decision to discharge the clinically stable patient having suffered a grade III or lower liver injury.