重度创伤患者的即时全身CT扫描与常规成像和选择性CT扫描 (REACT-2):一项随机对照试验
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
概括
与标准成像相比,即时全身CT扫描对创伤患者的存活率没有改善. 需要进一步的研究来确定哪些患者因辐射暴露而受益最多.
科学领域:
- 紧急医疗
- 放射学
- 创伤手术
背景情况:
- 之前的研究表明,在接受全身CT扫描 (TBCT) 的创伤患者中,存活率有所改善.
- 然而,缺乏支持这一益处的高层证据.
- 这项研究旨在评估TBCT对创伤患者住院死亡率的影响.
研究的目的:
- 将即时全身CT扫描与标准放射检查在减少创伤患者住院死亡率方面的有效性进行比较.
- 分析子组死亡率差异,包括多创伤和创伤性脑损伤患者.
主要方法:
- 进行了一项国际多中心随机对照试验,涉及荷兰和瑞士的五家医院.
- 1403名18岁及以上的创伤患者,有生命体征损伤或严重损伤,被随机分组 (1:1) 接受即时的TBCT或标准检查.
- 主要终点是住院死亡率,使用治疗意向原则进行分析.
主要成果:
- 在立即TBCT组 (16%) 和标准工作组 (16%; p=0. 92) 之间,住院死亡率没有显著差异.
- 对多创伤和创伤性脑损伤患者的亚组分析也显示,两组之间死亡率没有显著差异.
- 这两组患者的不良反应罕见且可比.
结论:
- 与标准放射检查相比,即时全身CT扫描并没有降低创伤患者的住院死亡率.
- 鉴于与TBCT相关的辐射暴露增加,未来的研究应专注于患者选择,以最大限度地获得益处.
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