Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: Results of a prospective study
Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: Results of a prospective study
复制标题
DOI：
10.1097/00005373-199709000-00003
复制
发表时间：
1997-09-01
影响因子：
--
通讯作者：
Schweiberer, L
中科院分区：
文献类型：
--
作者：
Trupka, A;Waydhas, C;Schweiberer, L
目的：本前瞻性研究的目的是评价早期胸部计算机断层扫描(TCT)在钝性胸部创伤的诊断中是否优于常规胸部X线片(CXR)，以及这些附加信息是否影响随后对严重创伤患者、患者和方法的早期处理的治疗决策。方法：在一项前瞻性研究中，连续103例有胸部创伤临床或放射学体征的患者(91例多发伤，9例单纯性胸部创伤)，报复性损伤严重程度评分为30分，平均缩写损伤评分为3分，结果：67例患者(65%)TCT发现了胸部创伤后漏诊的主要并发症(肺挫伤33例，气胸27例，置入胸管后残留气胸7例，血胸21例，胸管移位5例，横隔膜破裂2例，心肌破裂1例)，11例患者TCT仅显示较小的额外病理表现(肺不张、小胸腔积液)，其中14例CXR和TCT的病理结果相同，11例同时行CXR和TCT检查，未见病理改变。在检测肺挫伤(P<；0.001)、气胸(P<；0.005)和血胸(P<；在42名患者(41%)中，TCT的其他发现导致了治疗的改变：胸管放置、气胸或大出血的胸管矫正(n=31)、通风和呼吸护理模式的改变(n=14)、对骨折稳定处理的影响(n=12)、横隔膜撕裂的剖腹检查(n=2)、支气管镜检查治疗肺不张(n=2)、排除主动脉破裂(n=2)、气管插管(n=1)和心包穿刺术(n=1)，以评估TCT后所有这些治疗改变的疗效。成人呼吸窘迫综合征、简明伤害量表患者亚组死亡率>；两组患者的年龄(38岁比39岁)、平均损伤严重程度评分(33比39岁)、呼吸衰竭发生率(36比36%，56%)无统计学差异，但成人呼吸窘迫综合征(8比20%；P<；0.05)和死亡率(10比21%；P<；结论：TCT对钝性胸部创伤后胸部损伤的诊断具有较高的敏感性，在显示肺挫伤、气胸、血胸方面优于常规CXR。早期TCT影响了大量患者的治疗，因此，我们建议将TCT用于多发伤和疑似胸部创伤患者的初步诊断，因为对所有胸部损伤的早期和准确诊断以及足够的治疗结果可能会减少严重创伤合并钝性胸部创伤患者的并发症和改善预后。
Objective: The aim of this prospective study was to evaluate,whether early thoracic computed tomography (TCT) is superior to routine chest x-ray (CXR) in the diagnostic work-up of blunt thoracic trauma and whether the additional information influences subsequent therapeutic decisions on the early management of severely injured patients, Patients and Methods: In a prospective study of 103 consecutive patients with clinical or radiologic signs of chest trauma (91 multiple injured patients with chest trauma, nine patients with isolated chest trauma), an avenge Injury Severity Score of 30 and an average Abbreviated Injury Scale thorax score of 3, initial CXR and TCT were compared after initial assessment in our emergency department of a Level I trauma center, Results: In 67 patients (65%) TCT detected major chest trauma complications that have been missed on CXR (lung contusion (n = 33), pneumothorax (n = 27), residual pneumothorax after chest tube placement (n = 7), hemothorax (n = 21), displaced chest tube (n = 5), diaphragmatic rupture (n = 2), myocardial rupture (n = 1)), In 11 patients only minor additional pathologic findings (dystelectasis, small pleural effusion),were visualized on TCT, and in 14 patients CXR and TCT showed the same pathologic results, Eleven patients underwent both CXR and TCT without pathologic findings. The TCT scan was significantly more effective than routine CXR in detecting lug contusions (p < 0.001), pneumothorax (p < 0.005), and hemothorax (p < 0.05), In 42 patients (41%) the additional TCT findings resulted in a change of therapy: chest tube placement, chest tube correction of pneumothoraces or large hemothoraces (n = 31), change in mode of ventilation and respiratory care (n = 14), influence on the management of fracture stabilization (n = 12), laparotomy in cases of diaphragmatic lacerations (n = 2), bronchoscopy for atelectasis (n = 2), exclusion of aortic rupture (n = 2), endotracheal intubation (n = 1), and pericardiocentesis (n = 1), To evaluate the efficacy of all those therapeutic changes after TCT the rates of respiratory failure, adult respiratory distress syndrome, and mortality in the subgroup of patients with Abbreviated Injury Scale thorax score of > 2 were compared with a historical control group, consisting of 84 patients with multiple trauma and with blunt chest trauma Abbreviated Injury Scale thorax score of > 2, prospectively studied between 1986 and 1992, Age (38 vs. 39 years), average Injury Severity Score (33 vs, 38), and the rate of respiratory failure (36 vs, 56%) were not statistically different between the two groups, but the rates of adult respiratory distress syndrome (8 vs, 20%; p < 0.05) and mortality (10 vs, 21%;p < 0.05) were significantly reduced in the TCT group, Conclusions: TCT is highly sensitive in detecting thoracic injuries after blunt chest trauma and is superior to routine CXR in visualizing lung contusions, pneumothorax, and hemothorax. Early TCT influences therapeutic management in a significant number of patients, We therefore recommend TCT in the initial diagnostic work-up of patients with multiple injuries and with suspected chest trauma because early and exact diagnosis of all thoracic injuries along with sufficient therapeutic consequences may reduce complications and improve outcome of severely injured patients with blunt chest trauma.