使用胸部X射线来预测创伤性肺胸部的管胸切除术:一个单一机构的回顾性审查
Shruthi Srinivas1, Katelyn Henderson, Katherine C Bergus
1From the Department of Surgery (S.S., K.C.B.), College of Medicine (K.H.), Department of Radiology (A.J.), Division of Trauma, Critical Care, and Burns, Department of Surgery (H.B., C.V., B.M.T., J.R.C.), and Division of Thoracic Imaging, Department of Radiology (E.D.), The Ohio State University, Columbus, Ohio.
The journal of trauma and acute care surgery
|March 14, 2024
概括
胸部X射线 (CXR) 上的38毫米切线可以预测创伤性肺胸部 (PTX) 患者的管胸切除术 (TT) 的需要. 这一发现支持进一步调查CXR大小用于管理PTX.
科学领域:
- 医疗成像医学成像
- 胸部外科手术 胸部外科手术
- 创伤护理 创伤护理
背景情况:
- 创伤性肺胸 (PTX) 在胸部创伤中很常见.
- 管胸切除术 (TT) 是大多数PTX的标准管理方法.
- 对CT扫描的35毫米规则表明对较小的PTX进行观察,但其CXR对应物是未知的.
研究的目的:
- 为了确定胸部X射线 (CXR) 尺寸切断是否可以预测创伤性肺胸 (PTX) 中的管胸切除术 (TT) 的需要.
- 评估基于CXR的尺寸切断对管理PTX的有效性,类似于基于CT的35毫米规则.
主要方法:
- 对创伤性PTX患者 (2018-2022) 的回顾性评估,不包括那些以前有TT的患者.
- 主要结局:CXR上的PTX大小和TT的需要;次要结局:观测失败 (TT>4小时后).
- 通过AUROC分析和计算Youden指数,找出最佳的CXR大小切断值来预测TT需求.
主要成果:
- 在304名患者中,共分析了341个PTX;24%的患者需要在4小时内进行TT.
- 失败的观察发生在21.2%的观察患者中,CXR PTX大小较大 (p < 0.001).
- CXR PTX大小与CT大小相关 (r=0.31) 和预测的TT需要,最佳切线为38mm (AUC 0.75).
结论:
- CXR大小可以预测TT的需要,最佳切断距离为38毫米,接近35毫米CT规则.
- 乳酸和补充氧气的需要也预测了失败的观察.
- 38毫米的CXR切线值得对创伤性肺胸管理进行前性研究.
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