Vanessa P Ho, Sami K Kishawi, Hannah Hill, Joseph O'Brien, Asanthi Ratnasekera, Sirivan Suon Seng, Trieu Hai Ton, Christopher A Butts, Alison Muller, Bernardo Fabian Diaz, Gerard A Baltazar, Patrizio Petrone, Tulio Brasileiro Silva Pacheco, Shawna Morrissey, Timothy Chung, Jessica Biller, Lewis E Jacobson, Jamie M Williams, Cole S Nebughr, Pascal O Udekwu, Kimberly Tann, Charles Piehl, Jessica M Veatch, Thomas J Capasso, Eric J Kuncir, Lisa M Kodadek, Samuel M Miller, Defne Altan, Caleb Mentzer, Nicholas Damiano, Rachel Burke, Angela Earley, Stephanie Doris, Erica Villa, Michael C Wilkinson, Jacob K Dixon, Esther Wu, Melissa L Moncrief, Brandi Palmer, Karen Herzing, Tanya Egodage, Jennifer Williams, James Haan, Kelly Lightwine, Kristin P Colling, Melissa L Harry, Jeffry Nahmias, Erika Tay-Lasso, Joseph Cuschieri, Christopher J Hinojosa, Jeffrey A Claridge
{"title":"扫描老年人，尽量减少漏诊：EAST 多中心研究。","authors":"Vanessa P Ho, Sami K Kishawi, Hannah Hill, Joseph O'Brien, Asanthi Ratnasekera, Sirivan Suon Seng, Trieu Hai Ton, Christopher A Butts, Alison Muller, Bernardo Fabian Diaz, Gerard A Baltazar, Patrizio Petrone, Tulio Brasileiro Silva Pacheco, Shawna Morrissey, Timothy Chung, Jessica Biller, Lewis E Jacobson, Jamie M Williams, Cole S Nebughr, Pascal O Udekwu, Kimberly Tann, Charles Piehl, Jessica M Veatch, Thomas J Capasso, Eric J Kuncir, Lisa M Kodadek, Samuel M Miller, Defne Altan, Caleb Mentzer, Nicholas Damiano, Rachel Burke, Angela Earley, Stephanie Doris, Erica Villa, Michael C Wilkinson, Jacob K Dixon, Esther Wu, Melissa L Moncrief, Brandi Palmer, Karen Herzing, Tanya Egodage, Jennifer Williams, James Haan, Kelly Lightwine, Kristin P Colling, Melissa L Harry, Jeffry Nahmias, Erika Tay-Lasso, Joseph Cuschieri, Christopher J Hinojosa, Jeffrey A Claridge","doi":"10.1097/TA.0000000000004390","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite the high incidence of blunt trauma in older adults, there is a lack of evidence-based guidance for computed tomography (CT) imaging in this population. We aimed to identify an algorithm to guide use of a pan-scan (head/cervical spine [C-spine]/torso) or a selective scan (head/C-spine ± torso). We hypothesized that a patient's initial history and examination could be used to guide imaging.</p><p><strong>Methods: </strong>We prospectively studied blunt trauma patients 65 years or older at 18 Level I/II trauma centers. Patients presenting >24 hours after injury or who died upon arrival were excluded. We collected history and physical elements and final injury diagnoses. Injury diagnoses were categorized into CT body regions of head/C-spine or Torso (chest, abdomen/pelvis, and thoracolumbar spine). Using machine learning and regression modeling as well as a priori clinical algorithms based, we tested various decision rules against our data set. Our priority was to identify a simple rule, which could be applied at the bedside, maximizing sensitivity and negative predictive value (NPV) to minimize missed injuries.</p><p><strong>Results: </strong>We enrolled 5,498 patients with 3,082 injuries. Nearly half (n = 2,587 [47.1%]) had an injury within the defined CT body regions. No rule to guide a pan-scan could be identified with suitable sensitivity/NPV for clinical use. A clinical algorithm to identify patients for pan-scan, using a combination of physical examination findings and specific high-risk criteria, was identified and had a sensitivity of 0.94 and NPV of 0.86. This rule would have identified injuries in all but 90 patients (1.6%) and would theoretically spare 11.9% (655) of blunt trauma patients a torso CT.</p><p><strong>Conclusion: </strong>Our findings advocate for head/C-spine CT in all geriatric patients with the addition of torso CT in the setting of positive clinical findings and high-risk criteria. Prospective validation of this rule could lead to streamlined diagnostic care of this growing trauma population.</p><p><strong>Level of evidence: </strong>Diagnostic Tests or Criteria; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"101-110"},"PeriodicalIF":3.7000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599468/pdf/","citationCount":"0","resultStr":"{\"title\":\"Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study.\",\"authors\":\"Vanessa P Ho, Sami K Kishawi, Hannah Hill, Joseph O'Brien, Asanthi Ratnasekera, Sirivan Suon Seng, Trieu Hai Ton, Christopher A Butts, Alison Muller, Bernardo Fabian Diaz, Gerard A Baltazar, Patrizio Petrone, Tulio Brasileiro Silva Pacheco, Shawna Morrissey, Timothy Chung, Jessica Biller, Lewis E Jacobson, Jamie M Williams, Cole S Nebughr, Pascal O Udekwu, Kimberly Tann, Charles Piehl, Jessica M Veatch, Thomas J Capasso, Eric J Kuncir, Lisa M Kodadek, Samuel M Miller, Defne Altan, Caleb Mentzer, Nicholas Damiano, Rachel Burke, Angela Earley, Stephanie Doris, Erica Villa, Michael C Wilkinson, Jacob K Dixon, Esther Wu, Melissa L Moncrief, Brandi Palmer, Karen Herzing, Tanya Egodage, Jennifer Williams, James Haan, Kelly Lightwine, Kristin P Colling, Melissa L Harry, Jeffry Nahmias, Erika Tay-Lasso, Joseph Cuschieri, Christopher J Hinojosa, Jeffrey A Claridge\",\"doi\":\"10.1097/TA.0000000000004390\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite the high incidence of blunt trauma in older adults, there is a lack of evidence-based guidance for computed tomography (CT) imaging in this population. We aimed to identify an algorithm to guide use of a pan-scan (head/cervical spine [C-spine]/torso) or a selective scan (head/C-spine ± torso). We hypothesized that a patient's initial history and examination could be used to guide imaging.</p><p><strong>Methods: </strong>We prospectively studied blunt trauma patients 65 years or older at 18 Level I/II trauma centers. Patients presenting >24 hours after injury or who died upon arrival were excluded. We collected history and physical elements and final injury diagnoses. Injury diagnoses were categorized into CT body regions of head/C-spine or Torso (chest, abdomen/pelvis, and thoracolumbar spine). Using machine learning and regression modeling as well as a priori clinical algorithms based, we tested various decision rules against our data set. Our priority was to identify a simple rule, which could be applied at the bedside, maximizing sensitivity and negative predictive value (NPV) to minimize missed injuries.</p><p><strong>Results: </strong>We enrolled 5,498 patients with 3,082 injuries. Nearly half (n = 2,587 [47.1%]) had an injury within the defined CT body regions. No rule to guide a pan-scan could be identified with suitable sensitivity/NPV for clinical use. A clinical algorithm to identify patients for pan-scan, using a combination of physical examination findings and specific high-risk criteria, was identified and had a sensitivity of 0.94 and NPV of 0.86. This rule would have identified injuries in all but 90 patients (1.6%) and would theoretically spare 11.9% (655) of blunt trauma patients a torso CT.</p><p><strong>Conclusion: </strong>Our findings advocate for head/C-spine CT in all geriatric patients with the addition of torso CT in the setting of positive clinical findings and high-risk criteria. Prospective validation of this rule could lead to streamlined diagnostic care of this growing trauma population.</p><p><strong>Level of evidence: </strong>Diagnostic Tests or Criteria; Level II.</p>\",\"PeriodicalId\":17453,\"journal\":{\"name\":\"Journal of Trauma and Acute Care Surgery\",\"volume\":\" \",\"pages\":\"101-110\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599468/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Trauma and Acute Care Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/TA.0000000000004390\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/14 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Trauma and Acute Care Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TA.0000000000004390","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/14 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study.
Background: Despite the high incidence of blunt trauma in older adults, there is a lack of evidence-based guidance for computed tomography (CT) imaging in this population. We aimed to identify an algorithm to guide use of a pan-scan (head/cervical spine [C-spine]/torso) or a selective scan (head/C-spine ± torso). We hypothesized that a patient's initial history and examination could be used to guide imaging.
Methods: We prospectively studied blunt trauma patients 65 years or older at 18 Level I/II trauma centers. Patients presenting >24 hours after injury or who died upon arrival were excluded. We collected history and physical elements and final injury diagnoses. Injury diagnoses were categorized into CT body regions of head/C-spine or Torso (chest, abdomen/pelvis, and thoracolumbar spine). Using machine learning and regression modeling as well as a priori clinical algorithms based, we tested various decision rules against our data set. Our priority was to identify a simple rule, which could be applied at the bedside, maximizing sensitivity and negative predictive value (NPV) to minimize missed injuries.
Results: We enrolled 5,498 patients with 3,082 injuries. Nearly half (n = 2,587 [47.1%]) had an injury within the defined CT body regions. No rule to guide a pan-scan could be identified with suitable sensitivity/NPV for clinical use. A clinical algorithm to identify patients for pan-scan, using a combination of physical examination findings and specific high-risk criteria, was identified and had a sensitivity of 0.94 and NPV of 0.86. This rule would have identified injuries in all but 90 patients (1.6%) and would theoretically spare 11.9% (655) of blunt trauma patients a torso CT.
Conclusion: Our findings advocate for head/C-spine CT in all geriatric patients with the addition of torso CT in the setting of positive clinical findings and high-risk criteria. Prospective validation of this rule could lead to streamlined diagnostic care of this growing trauma population.
Level of evidence: Diagnostic Tests or Criteria; Level II.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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