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重度のトラウマの患者における即時全身CTスキャンと従来のイメージングおよび選択CTスキャン (REACT-2):ランダム化制御試験
Joanne C Sierink1, Kaij Treskes1, Michael J R Edwards2
1Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
Lancet (London, England)
|July 3, 2016
まとめ
トラウマ患者の全身CTスキャンでは 標準的なイメージングと比較して 生存率が向上しません 放射線被曝によるこのイメージング技術からどの患者が最も恩恵を受けるかを特定するには,さらなる研究が必要である.
科学分野:
- 緊急 医療
- 放射線科
- トラウマ 手術
背景:
- 過去の研究では,全身CTスキャン (TBCT) を受けたトラウマ患者の生存効果が示唆された.
- しかし,この利点を裏付ける高レベルの証拠は不足していた.
- この研究は,トラウマ患者の入院死亡率に対するTBCTの影響を評価することを目的とした.
研究 の 目的:
- トラウマ患者の入院死亡率を減らすために,全身CTスキャンと標準的な放射線検査の有効性を比較する.
- 多重外傷や脳外傷患者を含むサブグループにおける死亡率の違いを分析する.
主な方法:
- オランダとスイスの5つの病院を対象に,国際的,多センター,ランダム化制御試験が行われました.
- 18歳以上のトラウマ患者で,生命的徴候の低下や重度の傷害がある1403人を,即時のTBCTまたは標準的なワークアップにランダムに (1:1) 割り当てました.
- 主なエンドポイントは入院死亡率で,治療意図の原則を用いて分析された.
主要な成果:
- 病院での死亡率は,直接TBCTグループ (16%) と標準的なワークアップグループ (16%; p=0. 92) の間で有意に違わなかった.
- 多重外傷や脳外傷患者のサブグループ分析では,死亡率の有意な差も示されなかった.
- 2つのグループでは,有害事象はまれで,比較可能であった.
結論:
- トラウマ患者の病院での死亡率は 標準的な放射線検査と比較して減らない.
- TBCTに関連した放射線被曝の増加を考慮すると,将来の研究は患者の選択に重点を置くべきです.
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