Acil servise başvuran ayak ve ayak bileği travmalı hastalarda tedavi seçeneklerinin X-ray ve bilgisayarlı tomografi bulgularına göre karşılaştırılması

Öz

Amaç: Bu çalışmada, ayak ve/veya ayak bileği travması ile acil servise başvuran hastalarda direkt radyografi (X-ray) ve bilgisayarlı tomografinin (BT) patolojik bulguları saptamadaki farklılıklarının, tedavi gereksinimi ve değişimini öngörmedeki rolü araştırıldı. Gereçler ve Yöntemler: Çalışma, Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Acil Servisi’nde 1 Ocak 2017–31 Aralık 2019 tarihleri arasında gerçekleştirildi. Ayak ve/veya ayak bileği travması olan hastaların BT ve X-ray sonuçları ile klinik verileri retrospektif olarak değerlendirildi. Bulgular: Görüntüleme sonuçlarına göre hastaların %8,9’unda yalnızca BT’de, %24,9’unda ise hem X-ray hem BT’de patoloji saptanırken geri kalan grupta görüntüleme sonuçları normaldi. Hem X-ray hem BT’de patoloji bulunan olgularda Glasgow Koma Skoru ortalaması daha düşük saptandı (p=0,018). Yalnızca BT’de patoloji tespit edilen olgular, daha sık alçı/atel ile tedavi edilirken; her iki görüntülemede patoloji saptananlarda cerrahi girişim oranı anlamlı olarak daha yüksekti (p<0,001). Ayrıca sadece BT’de patoloji saptanan olgularda tedavi değişikliği gereksinimi diğer gruplara göre belirgin şekilde fazlaydı (p<0,001). Sonuç: Acil serviste ayak ve ayak bileği travmalarının yönetiminde doğru görüntüleme yönteminin seçilmesi, tanısal doğruluğu artırarak uygun tedaviye yön vermede kritik bir rol oynar. Özellikle X-ray ile saptanamayan patolojilerin BT ile ortaya konması, başvuru anında uygulanacak tedavi seçeneğinin belirlenmesinde yol gösterici olmasının yanı sıra tedavi değişikliği gereksinimini öngörmede de önemli katkı sağlayabilir.

Anahtar Kelimeler

• Acil servis
• Ayak travması
• Ayak bileği travması
• Radyografi
• Bilgisayarlı tomografi

Comparison of treatment options based on X-ray and computed tomography findings in patients presenting to the emergency department with foot and ankle trauma

Öz

Aim: This study investigated the differences between direct radiography (X-ray) and computed tomography (CT) in detecting pathological findings in patients presenting to the emergency department with foot and/or ankle trauma and evaluated their role in predicting treatment requirements and modifications. Materials and Methods: The study was conducted at the Emergency Department of Van Yüzüncü Yıl University Faculty of Medicine between January 1, 2017, and December 31, 2019. CT and X-ray results, along with clinical data of patients with foot and/or ankle trauma, were retrospectively analyzed. Results: Imaging revealed pathology only on CT in 8.9% of cases, on both CT and X-ray in 24.9%, while the remaining patients had normal imaging results. The mean Glasgow Coma Scale score was significantly lower in patients with pathology detected on both modalities (p = 0.018). Patients with CT-only findings were more frequently treated with splinting/casting, whereas surgical intervention rates were significantly higher in those with pathology on both imaging modalities (p < 0.001). Furthermore, the need for treatment modification was markedly greater in patients with CT-only pathology compared to other groups (p < 0.001). Conclusion: In the management of foot and ankle trauma in the emergency setting, selecting the appropriate imaging modality plays a critical role in enhancing diagnostic accuracy and guiding proper treatment. Particularly, CT is valuable in detecting injuries missed by X-ray, not only informing initial treatment decisions at admission but also providing important predictive value for subsequent treatment modifications.

Anahtar Kelimeler

• Emergency department
• Foot trauma
• Ankle trauma
• Radiography
• Computed tomography

Kaynakça

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