دورية أكاديمية
أعرض في EDS

Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?

التفاصيل البيبلوغرافية
العنوان: Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?
المؤلفون: Foster SM; Reading Trauma Center, Reading Hospital, Tower Health System, United States. Electronic address: Shannon.foster@towerhealth.org., Muller A; Reading Trauma Center, Reading Hospital, Tower Health System, United States., Conklin J; Reading Trauma Center, Reading Hospital, Tower Health System, United States., Cortes V; Reading Trauma Center, Reading Hospital, Tower Health System, United States., Fernandez FB; Reading Trauma Center, Reading Hospital, Tower Health System, United States., Geng TA Jr; Reading Trauma Center, Reading Hospital, Tower Health System, United States., Reilly EF; Reading Trauma Center, Reading Hospital, Tower Health System, United States., Sigal A; Reading Trauma Center, Reading Hospital, Tower Health System, United States., Ong AW; Reading Trauma Center, Reading Hospital, Tower Health System, United States.
المصدر: American journal of surgery [Am J Surg] 2019 Oct; Vol. 218 (4), pp. 755-759. Date of Electronic Publication: 2019 Jul 17.
نوع المنشور: Journal Article; Observational Study; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Excerpta Medica Country of Publication: United States NLM ID: 0370473 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1883 (Electronic) Linking ISSN: 00029610 NLM ISO Abbreviation: Am J Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: Belle Mead, NJ : Excerpta Medica
Original Publication: New York.
مواضيع طبية MeSH: Clinical Competence* , Clinical Decision-Making* , Tomography, X-Ray Computed*, Alcoholic Intoxication/*complications , Alcoholic Intoxication/*diagnostic imaging , Wounds, Nonpenetrating/*diagnostic imaging, Accidental Falls ; Adult ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Violence ; Wounds, Nonpenetrating/etiology
مستخلص: Background: We sought to determine if clinician suspicion of injury was useful in predicting injuries found on pan-body computed tomography (PBCT) in clinically intoxicated patients.
Methods: We prospectively enrolled awake, intoxicated patients with low-energy mechanism of injury. For each of four body regions (head/face, neck, thorax and abdomen/pelvis), clinician suspicion for injury was recorded as "low index" or "more than a low index". The reference standard was the presence of any pre-defined significant finding (SF) on CT. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios were calculated.
Results: Enrollment of 103 patients was completed. Sensitivity, specificity, LR+ and LR-for clinician index of suspicion were: 56%, 68%, 1.75, 0.64 (head/face), 50%, 92%, 6.18, 0.54 (neck), 10%, 96%, 2.60, 0.94 (thorax) and 67%, 93%, 9.56, 0.36 (abdomen/pelvis).
Conclusion: Clinician judgement was most useful to guide need for CT imaging in the neck and abdomen/pelvis. Routine PBCT may not be necessary.
Summary: For awake, stable intoxicated patients after falls and assaults, clinician index of suspicion was most useful to guide the need for CT imaging in the neck and abdomen/pelvis. Our findings support selective use of CT if the index of suspicion is low. Routine PBCT may not be necessary.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: Clinical judgement; Computed tomography; Intoxicated falls; Low energy trauma; Suspicion of injury
تواريخ الأحداث: Date Created: 20190729 Date Completed: 20200226 Latest Revision: 20200226
رمز التحديث: 20231215
DOI: 10.1016/j.amjsurg.2019.07.010
PMID: 31351577
قاعدة البيانات: MEDLINE
الوصف
تدمد:1879-1883
DOI:10.1016/j.amjsurg.2019.07.010