背景:颈部计算机断层扫描(CT)高度敏感,可以有效地排除颈椎,脑血管,以及钝性和穿透性创伤后的消化道损伤。然而,CT在评估悬挂或绞窄伤时可能会过度使用。这项研究的目的是确定在加拿大一级创伤中心评估悬吊或绞窄机制的患者中CT成像的诊断率。
方法:对所有成人患者进行了为期8年的悬吊或绞窄损伤评估。主要结果是CT成像对主要呼吸消化的诊断率,颈椎,脑血管,或者神经损伤.进行了多元逻辑回归以确定使用CT成像和识别成像损伤的预测因素。
结果:在研究期间被评估为悬吊或绞窄伤的124例患者中,101(80%)用头部或颈部的CT进行了评估。在21例患者中确定了26例受伤(18例缺氧性脑损伤,4呼吸消化,3脑血管,颈椎损伤1)。颈部CT对颈部损伤的总诊断率为7.8%,喉气管损伤占4.7%,颈动脉和椎动脉损伤占3.5%,颈椎损伤为1.1%。CT头颅对缺氧性脑损伤的诊断率为22.8%。预测使用CT成像的因素是异常体检结果(RR1.795%CI[1.2,2.3])和创伤小组组长接受的转移(RR1.395%CI[1.1,1.5])。
结论:CT成像通常用于评估有悬吊或绞窄机制的患者。七个脑血管,呼吸消化,或颈椎损伤在研究期间的影像学上被发现,代表7%的诊断率。在GCS或体格检查正常的患者中未发现损伤。预测使用CT成像的因素包括创伤小组负责人接受的转移和异常的体检结果。近悬挂和绞窄伤的临床表现多变,CT成像的诊断率相对较低,应促使开发工具和机构协议,以指导悬挂和绞窄伤的评估。
BACKGROUND: Computed tomography (CT) of the neck is highly sensitive and may effectively rule-out cervical spine, cerebrovascular, and aerodigestive injuries after blunt and penetrating trauma. However, CT may be overutilized in the evaluation of hanging or strangulation injuries. The objective of this study was to determine the diagnostic yield of CT imaging among patients evaluated for hanging or strangulation mechanisms at a Canadian level-1 trauma center.
METHODS: All adult patients evaluated for hanging or strangulation injuries over an eight-year period were reviewed. The primary outcome was the diagnostic yield of CT imaging for major aerodigestive, cervical spine, cerebrovascular, or neurological injuries. Multiple logistic regression were performed to determine predictive factors for the use of CT imaging and the identification of injury on imaging.
RESULTS: Among 124 patients evaluated for hanging or strangulation injuries during the study period, 101 (80%) were evaluated with CT of the head or neck. A total of 26 injuries were identified in 21 patients (18 anoxic brain injuries, 4 aerodigestive, 3 cerebrovascular, and 1 of cervical spine injury). The overall diagnostic yield of neck CT for cervical injuries was 7.8%, 4.7% for laryngeal-tracheal injuries, 3.5% for carotid and vertebral artery injuries, and 1.1% for cervical spine injury. The diagnostic yield of CT head for anoxic brain injury was 22.8%. Factors predicting the use of CT imaging were abnormal physical exam findings (RR 1.7 95% CI [1.2, 2.3]) and transfer accepted by the trauma team leader (RR 1.3 95% CI [1.1, 1.5]).
CONCLUSIONS: CT imaging is often used in the evaluation of patients presenting with hanging or strangulation mechanisms. Seven cerebrovascular, aerodigestive, or cervical spine injuries were identified on imaging during the study period, representing a diagnostic yield of 7%. No injuries were identified among patient with a normal GCS or physical exam. Factors predicting the use of CT imaging included transfer accepted by the trauma team leader and abnormal physical exam findings. The variable clinical presentation of near-hanging and strangulation injuries and the relatively low diagnostic yield of CT imaging should prompt the development of tools and institutional protocols to guide the evaluation of hanging and strangulation injuries.