Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ho Vanessa P, Kishawi Sami K, Hill Hannah, O'Brien Joseph, Ratnasekera Asanthi, Seng Sirivan Suon, Ton Trieu Hai, Butts Christopher A, Muller Alison, Diaz Bernardo Fabian, Baltazar Gerard A, Petrone Patrizio, Pacheco Tulio Brasileiro Silva, Morrissey Shawna, Chung Timothy, Biller Jessica, Jacobson Lewis E, Williams Jamie M, Nebughr Cole S, Udekwu Pascal O, Tann Kimberly, Piehl Charles, Veatch Jessica M, Capasso Thomas J, Kuncir Eric J, Kodadek Lisa M, Miller Samuel M, Altan Defne, Mentzer Caleb, Damiano Nicholas, Burke Rachel, Earley Angela, Doris Stephanie, Villa Erica, Wilkinson Michael C, Dixon Jacob K, Wu Esther, Moncrief Melissa L, Palmer Brandi, Herzing Karen, Egodage Tanya, Williams Jennifer, Haan James, Lightwine Kelly, Colling Kristin P, Harry Melissa L, Nahmias Jeffry, Tay-Lasso Erika, Cuschieri Joseph, Hinojosa Christopher J, Claridge Jeffrey A
Аннотация
METHODS: We prospectively studied blunt trauma patients 65 years or older at 18 Level I/II trauma centers. Patients presenting >24 hours after injury or who died upon arrival were excluded. We collected history and physical elements and final injury diagnoses. Injury diagnoses were categorized into CT body regions of head/C-spine or Torso (chest, abdomen/pelvis, and thoracolumbar spine). Using machine learning and regression modeling as well as a priori clinical algorithms based, we tested various decision rules against our data set. Our priority was to identify a simple rule, which could be applied at the bedside, maximizing sensitivity and negative predictive value (NPV) to minimize missed injuries.
RESULTS: We enrolled 5,498 patients with 3,082 injuries. Nearly half (n = 2,587 [47.1%]) had an injury within the defined CT body regions. No rule to guide a pan-scan could be identified with suitable sensitivity/NPV for clinical use. A clinical algorithm to identify patients for pan-scan, using a combination of physical examination findings and specific high-risk criteria, was identified and had a sensitivity of 0.94 and NPV of 0.86. This rule would have identified injuries in all but 90 patients (1.6%) and would theoretically spare 11.9% (655) of blunt trauma patients a torso CT.
CONCLUSION: Our findings advocate for head/C-spine CT in all geriatric patients with the addition of torso CT in the setting of positive clinical findings and high-risk criteria. Prospective validation of this rule could lead to streamlined diagnostic care of this growing trauma population.
LEVEL OF EVIDENCE: Diagnostic Tests or Criteria; Level II.