Araştırma Makalesi
PDF Zotero Mendeley EndNote BibTex Kaynak Göster

Minör Travma Hastalarının Yönetiminde Tüm Vücut Bilgisayarlı Tomografinin Rolünün Değerlendirilmesi

Yıl 2021, Cilt 11, Sayı 6, 883 - 888, 20.11.2021
https://doi.org/10.16899/jcm.980536

Öz

 Amaç: Tüm vücut bilgisayarlı tomografi (TVBT) yaklaşımı, klinisyenler tarafından sadece majör travma hastaları için değil, hatta minör travma hastaları için de dünya çapında geleneksel seçilmiş BT yaklaşımına göre giderek daha fazla tercih edilmektedir. Amacımız, TVBT ile görüntülenen minör travma hastalarında çoklu travma hastalarının oranını belirlemek ve çoklu travmanın demografik ve klinik belirleyicilerini belirlemekti.
Gereç ve Yöntem: Bu retrospektif-tanımlayıcı-çalışma, acil serviste 16 yaşından büyük ancak injury severty skoru <16 olan ve Ocak 2015 ile Aralık 2018 tarihleri arasında, WBCT çekilmiş olan travma hastalarının verileri incelenerek yapıldı. En az iki vücut bölgesinde tomografi sonuçlarına göre abbreviated injury scale skoru ≥2 olan yaralanma varlığı çalışmanın birincil sonlanımı olarak belirlendi.
Bulgular: Çalışmaya toplam 3924 hastanın verileri dahil edildi. Tüm hastaların sadece 278'inde (%7,1) çoklu travma tespit edildi. Çoklu lojistik regresyon analiz sonuçlarına göre, yüksekten düşme (>3 metre), yayaya araç çarpması, değişen mental durum (GCS <14) ve erkek cinsiyet, çoklu travma varlığı için anlamlı değişkenler olarak bulundu. Bu değişkenlerle bir model oluşturulduğunda, bu modelin 0,6 (%95 CI: 0,59 ila 0,72) gibi düşük tanısal doğruluk değerine sahip olduğu bulunmuştur.
Sonuç: Çoklu travma ve mortalite oranı küçük olan sadece minör travma hastaları düşünüldüğünde, TVBT yaklaşımının rutin kullanımı akılcı değildir. Çalışmamızda bulunan prediktörler, minör travma hastaları için gelecekte klinik bir karar kuralı geliştirmek için kullanılabilir. 

Kaynakça

  • 1. Smith CM, Woolrich-Burt L, Wellings R, Costa ML. Major trauma CT scanning: the experience of a regional trauma centre in the UK. Emerg Med J. 2011 May;28(5):378–82.
  • 2. Çorbacıoğlu SK, Er E, Aslan S, Seviner M, Aksel G, Doğan NÖ, et al. The significance of routine thoracic computed tomography in patients with blunt chest trauma. Injury. 2015 May;46(5):849–53.
  • 3. Çorbacıoğlu ŞK, Aksel G. Whole body computed tomography in multi trauma patients: Review of the current literature. Turk J Emerg Med. 2018 Dec;18(4):142–7.
  • 4. Huber-Wagner S, Lefering R, Qvick L-M, Körner M, Kay MV, Pfeifer K-J, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. The Lancet. 2009;373(9673):1455–1461.
  • 5. Huber-Wagner S, Biberthaler P, Häberle S, Wierer M, Dobritz M, Rummeny E, et al. Whole-Body CT in Haemodynamically Unstable Severely Injured Patients – A Retrospective, Multicentre Study. PLoS One [Internet]. 2013 Jul 24 [cited 2020 Apr 9];8(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722202/
  • 6. Weninger P, Mauritz W, Fridrich P, Spitaler R, Figl M, Kern B, et al. Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. Journal of Trauma and Acute Care Surgery. 2007;62(3):584–591.
  • 7. Hutter M, Woltmann A, Hierholzer C, Gärtner C, Bühren V, Stengel D. Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2011;19(1):73.
  • 8. Wurmb TE, Frühwald P, Hopfner W, Keil T, Kredel M, Brederlau J, et al. Whole-body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time. Journal of Trauma and Acute Care Surgery. 2009;66(3):658–665.
  • 9. Mao Shanlin X, Xinfa XY, Hongfei W, Lijun L. The value of whole-body CT in severe traffic trauma patients during the early resuscitation phase. Chinese J Trauma. 2012;28(3):269–271.
  • 10. Kimura A, Tanaka N. Whole-body computed tomography is associated with decreased mortality in blunt trauma patients with moderate-to-severe consciousness disturbance: a multicenter, retrospective study. Journal of Trauma and Acute Care Surgery. 2013;75(2):202–206.
  • 11. Hsiao KH, Dinh MM, McNamara KP, Bein KJ, Roncal S, Saade C, et al. Whole-body computed tomography in the initial assessment of trauma patients: Is there optimal criteria for patient selection? Emergency Medicine Australasia. 2013;25(2):182–191.
  • 12. Sierink JC, Treskes K, Edwards MJ, Beuker BJ, den Hartog D, Hohmann J, et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. The Lancet. 2016;388(10045):673–683.
  • 13. Aksel G, Bildik F, Demircan A, Keles A, Kilicaslan I, Guler S, et al. Effects of fast-track in a university emergency department through the National Emergency Department Overcrowding Study. J Pak Med Assoc. 2014;64(7):791–7.
  • 14. Davies RM, Scrimshire AB, Sweetman L, Anderton MJ, Holt EM. A decision tool for whole-body CT in major trauma that safely reduces unnecessary scanning and associated radiation risks: An initial exploratory analysis. Injury. 2016 Jan;47(1):43–9.
  • 15. Sampson MA, Colquhoun KBM, Hennessy NLM. Computed tomography whole body imaging in multi-trauma: 7 years experience. Clin Radiol. 2006 Apr;61(4):365–9.
  • 16. Belabbas D, Auger M, Lederlin M, Bonenfant J, Gandon Y, Aubé C, et al. Whole-Body CT after Motor Vehicle Crash: No Benefit after High-Energy Impact and with Normal Physical Examination. Radiology. 2019 Jul;292(1):94–100.
  • 17. Sierink JC, Saltzherr TP, Beenen LFM, Russchen MJAM, Luitse JSK, Dijkgraaf MGW, et al. A case-matched series of immediate total-body CT scanning versus the standard radiological work-up in trauma patients. World J Surg. 2014 Apr;38(4):795–802.
  • 18. Qamar SR, Evans D, Gibney B, Redmond C, Nasir MU, Wong K, et al. Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making. Can Assoc Radiol J. 2020 Apr 8;846537120914247.
  • 19. Babaud J, Ridereau-Zins C, Bouhours G, Lebigot J, Le Gall R, Bertrais S, et al. Benefit of the Vittel criteria to determine the need for whole body scanning in a severe trauma patient. Diagnostic and Interventional Imaging. 2012 May;93(5):371–9.

Evaluation of the role of whole body computed tomography in the management of minor trauma patients.

Yıl 2021, Cilt 11, Sayı 6, 883 - 888, 20.11.2021
https://doi.org/10.16899/jcm.980536

Öz

ABSTRACT Aim: Whole body of computed tomography (WBCT) approach is increasingly being preferred by the clinicians over the traditional selected CT approach worldwide, not only for major trauma patients but even for minor trauma patients. Our aim was to determine the ratio of polytrauma patients in minor trauma patients imaged with WBCT and to determine demographical and clinical predictors of polytrauma. Methods: This retrospective-descriptive-study was conducted at the emergency department with patients older than 16 but had an injury severity scores of less than 16 and those who underwent WBCT trauma patients between January 2015 and December 2018. The presence of polytrauma, which defined presence of injury with an abbreviated injury scale score ≥2 according to tomography results in at least two body regions, was considered as the primary outcome of the study. Results: Total 3924 (ISS<16) patients’ data were enrolled in the study. Only in 278 of all patients (7.1%) polytrauma was detected. After the multi-logistic regression analysis, fall from height (>3 meters), pedestrian struck, altered mental status (GCS <14), and male sex were found as significant predictor factors for presence of polytrauma. When created a model with these parameters, it was found that it had low diagnostic accuracy value as 0.6 (95%CI: 0.59 to 0.72). Conclusion: When considered only minor trauma patients with small polytrauma and mortality ratio, routine using of WBCT approach is not rational. The predictors found in our study can be used to develop a clinical decision rule in the future for minor trauma patients. ÖZET Amaç: Tüm vücut bilgisayarlı tomografi (TVBT) yaklaşımı, klinisyenler tarafından sadece majör travma hastaları için değil, hatta minör travma hastaları için de dünya çapında geleneksel seçilmiş BT yaklaşımına göre giderek daha fazla tercih edilmektedir. Amacımız, TVBT ile görüntülenen minör travma hastalarında çoklu travma hastalarının oranını belirlemek ve çoklu travmanın demografik ve klinik belirleyicilerini belirlemekti. Yöntemler: Bu retrospektif-tanımlayıcı-çalışma, acil serviste 16 yaşından büyük ancak injury severty skoru <16 olan ve Ocak 2015 ile Aralık 2018 tarihleri arasında, WBCT çekilmiş olan travma hastalarının verileri incelenerek yapıldı. En az iki vücut bölgesinde tomografi sonuçlarına göre abbreviated injury scale skoru ≥2 olan yaralanma varlığı çalışmanın birincil sonlanımı olarak belirlendi. Bulgular: Çalışmaya toplam 3924 hastanın verileri dahil edildi. Tüm hastaların sadece 278'inde (%7.1) çoklu travma tespit edildi. Çoklu lojistik regresyon analiz sonuçlarına göre, yüksekten düşme (>3 metre), yayaya araç çarpması, değişen mental durum (GCS <14) ve erkek cinsiyet, çoklu travma varlığı için anlamlı değişkenler olarak bulundu. Bu değişkenlerle bir model oluşturulduğunda, bu modelin 0,6 (%95 CI: 0,59 ila 0,72) gibi düşük tanısal doğruluk değerine sahip olduğu bulunmuştur. Sonuç: Çoklu travma ve mortalite oranı küçük olan sadece minör travma hastaları düşünüldüğünde, TVBT yaklaşımının rutin kullanımı akılcı değildir. Çalışmamızda bulunan prediktörler, minör travma hastaları için gelecekte klinik bir karar kuralı geliştirmek için kullanılabilir.

Kaynakça

  • 1. Smith CM, Woolrich-Burt L, Wellings R, Costa ML. Major trauma CT scanning: the experience of a regional trauma centre in the UK. Emerg Med J. 2011 May;28(5):378–82.
  • 2. Çorbacıoğlu SK, Er E, Aslan S, Seviner M, Aksel G, Doğan NÖ, et al. The significance of routine thoracic computed tomography in patients with blunt chest trauma. Injury. 2015 May;46(5):849–53.
  • 3. Çorbacıoğlu ŞK, Aksel G. Whole body computed tomography in multi trauma patients: Review of the current literature. Turk J Emerg Med. 2018 Dec;18(4):142–7.
  • 4. Huber-Wagner S, Lefering R, Qvick L-M, Körner M, Kay MV, Pfeifer K-J, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. The Lancet. 2009;373(9673):1455–1461.
  • 5. Huber-Wagner S, Biberthaler P, Häberle S, Wierer M, Dobritz M, Rummeny E, et al. Whole-Body CT in Haemodynamically Unstable Severely Injured Patients – A Retrospective, Multicentre Study. PLoS One [Internet]. 2013 Jul 24 [cited 2020 Apr 9];8(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722202/
  • 6. Weninger P, Mauritz W, Fridrich P, Spitaler R, Figl M, Kern B, et al. Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. Journal of Trauma and Acute Care Surgery. 2007;62(3):584–591.
  • 7. Hutter M, Woltmann A, Hierholzer C, Gärtner C, Bühren V, Stengel D. Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2011;19(1):73.
  • 8. Wurmb TE, Frühwald P, Hopfner W, Keil T, Kredel M, Brederlau J, et al. Whole-body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time. Journal of Trauma and Acute Care Surgery. 2009;66(3):658–665.
  • 9. Mao Shanlin X, Xinfa XY, Hongfei W, Lijun L. The value of whole-body CT in severe traffic trauma patients during the early resuscitation phase. Chinese J Trauma. 2012;28(3):269–271.
  • 10. Kimura A, Tanaka N. Whole-body computed tomography is associated with decreased mortality in blunt trauma patients with moderate-to-severe consciousness disturbance: a multicenter, retrospective study. Journal of Trauma and Acute Care Surgery. 2013;75(2):202–206.
  • 11. Hsiao KH, Dinh MM, McNamara KP, Bein KJ, Roncal S, Saade C, et al. Whole-body computed tomography in the initial assessment of trauma patients: Is there optimal criteria for patient selection? Emergency Medicine Australasia. 2013;25(2):182–191.
  • 12. Sierink JC, Treskes K, Edwards MJ, Beuker BJ, den Hartog D, Hohmann J, et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. The Lancet. 2016;388(10045):673–683.
  • 13. Aksel G, Bildik F, Demircan A, Keles A, Kilicaslan I, Guler S, et al. Effects of fast-track in a university emergency department through the National Emergency Department Overcrowding Study. J Pak Med Assoc. 2014;64(7):791–7.
  • 14. Davies RM, Scrimshire AB, Sweetman L, Anderton MJ, Holt EM. A decision tool for whole-body CT in major trauma that safely reduces unnecessary scanning and associated radiation risks: An initial exploratory analysis. Injury. 2016 Jan;47(1):43–9.
  • 15. Sampson MA, Colquhoun KBM, Hennessy NLM. Computed tomography whole body imaging in multi-trauma: 7 years experience. Clin Radiol. 2006 Apr;61(4):365–9.
  • 16. Belabbas D, Auger M, Lederlin M, Bonenfant J, Gandon Y, Aubé C, et al. Whole-Body CT after Motor Vehicle Crash: No Benefit after High-Energy Impact and with Normal Physical Examination. Radiology. 2019 Jul;292(1):94–100.
  • 17. Sierink JC, Saltzherr TP, Beenen LFM, Russchen MJAM, Luitse JSK, Dijkgraaf MGW, et al. A case-matched series of immediate total-body CT scanning versus the standard radiological work-up in trauma patients. World J Surg. 2014 Apr;38(4):795–802.
  • 18. Qamar SR, Evans D, Gibney B, Redmond C, Nasir MU, Wong K, et al. Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making. Can Assoc Radiol J. 2020 Apr 8;846537120914247.
  • 19. Babaud J, Ridereau-Zins C, Bouhours G, Lebigot J, Le Gall R, Bertrais S, et al. Benefit of the Vittel criteria to determine the need for whole body scanning in a severe trauma patient. Diagnostic and Interventional Imaging. 2012 May;93(5):371–9.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Gökhan AKSEL (Sorumlu Yazar)
Emergency Medicine Department, University of Health Sciences, Umraniye Training and Research Hospital
0000-0002-5580-3201
Türkiye


İbrahim ALTUNOK
Emergency Medicine Department, University of Health Sciences, Umraniye Training and Research Hospital
0000-0002-9312-1025
Türkiye


Şeref Kerem ÇORBACIOĞLU
Emergency Medicine Department, University of Health Sciences, Kecioren Training and Research Hospital
0000-0001-7802-8087
Türkiye


Hatice Şeyma AKÇA
Emergency Medicine Department, University of Health Sciences, Umraniye Training and Research Hospital
0000-0003-2823-9577
Türkiye


Öner BOZAN
Emergency Medicine Department, University of Health Sciences, Okmeydani Training and Research Hospital
0000-0002-4195-2601
Türkiye


Kamil KOKULU
AKSARAY UNIVERSITY, SCHOOL OF MEDICINE
0000-0002-6132-0898
Türkiye


Serdar ÖZDEMİR
Emergency Medicine Department, University of Health Sciences, Umraniye Training and Research Hospital
0000-0002-6186-6110
Türkiye


Serkan Emre EROĞLU
University of Health Sciences Umraniye Training and Research Hospital, Emergency Medicine Clinic
0000-0002-3183-3713
Türkiye


Can ÖZEN Bu kişi benim
Emergency Department, King’s College Hospital, London, United Kingdom.
0000-0003-2691-847X
Türkiye


Mehmet Muzaffer İSLAM
University of Health Sciences Umraniye Training and Research Hospital, Emergency Medicine Clinic
0000-0001-6928-2307
Türkiye

Destekleyen Kurum Yok
Proje Numarası Yok
Yayımlanma Tarihi 20 Kasım 2021
Kabul Tarihi 24 Ağustos 2021
Yayınlandığı Sayı Yıl 2021, Cilt 11, Sayı 6

Kaynak Göster

AMA Aksel G. , Altunok İ. , Çorbacıoğlu Ş. K. , Akça H. Ş. , Bozan Ö. , Kokulu K. , Özdemir S. , Eroğlu S. E. , Özen C. , İslam M. M. Evaluation of the role of whole body computed tomography in the management of minor trauma patients.. J Contemp Med. 2021; 11(6): 883-888.