Computed tomography benefits and cost in hemodynamically stable patients with blunt abdominal trauma at an Egyptian University Hospital

IF 1.4 4区 医学 Q3 EMERGENCY MEDICINE African Journal of Emergency Medicine Pub Date : 2024-04-30 DOI:10.1016/j.afjem.2023.11.006
Mohamed A. Abdel Hamid , Mohammad A. Abd-erRazik , Mostafa Nagy , Mohamed El-Shinawi , Jon M. Hirshon , Maged El-Setouhy
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Abstract

Background

Trauma is a significant cause of mortality, especially among individuals aged between 15 and 44 years, with a substantial burden falling on economically active populations. Low- and middle-income countries (LMICs) bear the burden of trauma-related deaths, accounting for over 90 % globally. In Egypt, trauma rates are increasing, primarily due to road traffic crashes (RTC), affecting males disproportionately. Blunt abdominal trauma, often caused by RTC, can lead to missed intra-abdominal injuries (IAIs) due to atypical symptoms. Computed Tomography (CT) offers high sensitivity and specificity in detecting IAIs, but concerns about cost and radiation exposure exist.

Methodology

This study investigates the roles of Focused Assessment with Sonography for Trauma (FAST) and CT in managing blunt abdominal trauma. A retrospective cohort study was conducted on hemodynamically stable patients. Data included patient demographics, trauma details, healthcare decisions, costs, and outcomes.

Results

Computed tomography significantly reduced unnecessary laparotomies (12.3% vs. 24.8 %, p = 0.001), shortened hospital stays (4.83±0.71 days vs. 6.15±1.28 days, p = 0.005), and reduced ICU admissions (8 vs. 32, p = 0.023) compared to FAST alone. Overall costs were lower in the CT & FAST Group ($2055.95 vs. $3488.7, p = 0.0001), with no significant difference in missed IAIs.

Conclusion

This study highlights the limitations of relying solely on FAST for IAIs and underscores the value of CT in guiding healthcare decisions. Incorporating CT led to reduced negative laparotomies, shorter hospital stays, and fewer ICU admissions. While CT incurs initial costs, its long-term benefits outweigh expenditures, particularly in LMICs. This study provides insights into optimizing diagnostic approaches for blunt abdominal trauma in low-resource settings.

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埃及一所大学医院对血流动力学稳定的腹部钝挫伤患者进行计算机断层扫描的益处和成本
背景创伤是导致死亡的一个重要原因,尤其是在 15 至 44 岁的人群中,经济活跃人口承受着沉重的负担。中低收入国家(LMICs)承受着与创伤相关的死亡负担,占全球的 90% 以上。在埃及,创伤发生率正在上升,主要原因是道路交通事故(RTC),男性受到的影响尤为严重。腹部钝性创伤通常由道路交通事故(RTC)引起,由于症状不典型,可能导致腹部内伤(IAI)的漏诊。计算机断层扫描(CT)在检测腹腔内损伤(IAI)方面具有较高的灵敏度和特异性,但存在成本和辐射暴露方面的问题。本研究对血流动力学稳定的患者进行了回顾性队列研究。结果与单独使用 FAST 相比,CT 显著减少了不必要的开腹手术(12.3% vs. 24.8%,p = 0.001),缩短了住院时间(4.83±0.71 天 vs. 6.15±1.28天,p = 0.005),减少了 ICU 入院人数(8 vs. 32,p = 0.023)。CT & 组和 FAST 组的总成本较低(2055.95 美元 vs. 3488.7 美元,p = 0.0001),但在漏诊的 IAI 方面没有显著差异。采用 CT 可减少负性开腹手术、缩短住院时间并减少入住重症监护病房的人数。虽然 CT 会产生初始成本,但其长期效益大于支出,尤其是在低收入国家。这项研究为优化低资源环境下腹部钝性创伤的诊断方法提供了启示。
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来源期刊
CiteScore
2.40
自引率
7.70%
发文量
78
审稿时长
85 days
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