Whole-Body CT in Patients with Multiple Traumas: Factors Leading to Missed Injury
Whole-Body CT in Patients with Multiple Traumas: Factors Leading to Missed Injury
复制标题
DOI：
10.1148/radiol.2018180492
复制
发表时间：
2018-11-01
期刊：
影响因子：
19.7
通讯作者：
Millet, Ingrid
中科院分区：
文献类型：
--
作者：
Banaste, Nathan;Caurier, Berenice;Millet, Ingrid
目的：探讨早期全身CT图像解读中漏诊损伤的影像学及临床指标。材料与方法：本回顾性研究选取2011年2月至2016年9月在某远程放射学中心随叫随到期间对26家医院的多发创伤患者进行了2354次连续全身CT检查。所有的全身CT图像由当值放射科医生解释，并在12-48小时内由另一位放射科医生检查，以发现遗漏的损伤作为参考标准。对所有检查的初次报告和复查报告进行回顾性审查。采用逐步选择的单变量和多变量logistic回归方法来确定漏诊损伤的临床和放射学预测因素。结果：本研究纳入639名女性（27.1%）和1715名男性（72.8%）。男性、女性和整个人群的中位年龄为34岁（年龄范围为1-96岁）。在每次扫描的基础上，304例（12.9%）未发现损伤，59例（2.5%）具有临床意义。在每次受伤的基础上，5979人中有530人未受伤（8.8%）。两个以上身体部位受伤（优势比为1.4[95%可信区间：1.1,1.8],P = 0.01）、患者年龄大于30岁（优势比为2.8[95%可信区间：2.1,3.8],P < 0.001）、初始临床严重程度等级为1（优势比为1.9[95%可信区间：1.3,2.8],P < 0.001）是漏伤的独立预测因素。结论：多发创伤伴两个以上身体部位损伤，年龄大于30岁，或初始临床严重程度等级为1的患者与全身CT未见损伤相关。(c) RSNA， 2018年
Purpose: To determine radiologic and clinical markers predictive of missed injuries at early whole-body CT image interpretation.Materials and Methods: For this retrospective study, 2354 consecutive whole-body CT examinations were performed in patients with multiple traumas from 26 hospitals interpreted at a teleradiology center study during on-call period from February 2011 to September 2016. All whole-body CT images were interpreted by the on-call radiologist and reviewed within 12-48 hours by another radiologist to detect missed injury as the standard of reference. The first and review reports of all examinations were retrospectively reviewed. Univariable and multivariable logistic regression with a stepwise selection method were performed to identify clinical and radiologic predictors of missed injury.Results: This study included 639 women (27.1%) and 1715 men (72.8%). The median age of men, women, and the entire population was 34 years (age range, 1-96 years). On a per-scan basis, there were 304 (12.9%) missed injuries and 59 (2.5%) were clinically significant. On a per-injury basis, the missed injury rate was 530 of 5979 (8.8%). More than two injured body parts (odds ratio, 1.4 [95% confidence interval: 1.1, 1.8]; P = .01), patient age older than 30 years (odds ratio, 2.8 [95% confidence interval: 2.1, 3.8]; P < .001), and an initial clinical severity class of 1 (odds ratio, 1.9 [95% confidence interval: 1.3, 2.8]; P < .001) were independent predictive factors of missed injury.Conclusion: Multiple traumas with more than two injured body parts, age older than 30 years, or an initial clinical severity class of 1 were associated with missed injury at whole-body CT. (c) RSNA, 2018