FAST D方案:一种排除下肢创伤性血管损伤的简单方法。

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Critical Ultrasound Journal Pub Date : 2017-12-01 Epub Date: 2017-03-21 DOI:10.1186/s13089-017-0063-2
Miguel Angel Montorfano, Lisandro Miguel Montorfano, Federico Perez Quirante, Federico Rodríguez, Leonardo Vera, Luca Neri
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引用次数: 17

摘要

背景:本研究的目的是评估快速多普勒检查下肢损伤的准确性,即两点快速多普勒(2PFD),以便在穿透性创伤后快速分诊动脉病变。方法:对140例射穿伤患者的149条肢体进行标准化彩色双多普勒(SD)评估前,评估下肢足背动脉(DPA)和胫后动脉(PTA)血流情况及多普勒波形。我们将2PFD正常检查视为DPA和PTA均有三相流模式的检查,将2PFD病理检查视为DPA和/或PTA无、双相或单相流模式的检查。然后分析2PFD数据以评估准确性变量,使用SD结果作为匹配测试参考。根据创伤中心标准方案,SD阳性病例还进行了血管造影和手术探查,其结果用于进一步匹配2PFD的特异性。结果:与SD相比,2PFD方案对穿透性创伤后下肢动脉损伤的诊断敏感性为100%,特异性为100%。此外,与SD相比,所有病理病例均为真阳性(TP),与血管造影评估结果相匹配时也证实为真阳性。结论:2PFD方案可以快速识别动脉血流,并区分远端动脉的正常和病理谱多普勒分析。在排除下肢穿透性损伤动脉病变方面,DPA和PTA正常三相血流的存在与全肢标准化彩色多普勒双工评估一样敏感。在DPA和PTA中没有血流或出现双相或单相病理性血流是病理性的,应始终进行进一步的调查。与SD方法相比,2PFD更快,更容易执行。它可以成为一种新的一线筛查技术,无论是在院前还是在医院危急情况下,特别是在先进诊断性能受到时间问题或资源稀缺限制的情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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The FAST D protocol: a simple method to rule out traumatic vascular injuries of the lower extremities.

Background: The aim of this study is to assess the accuracy of a Fast Doppler protocol for the examination of an injured lower limb, namely 2-Point Fast Doppler (2PFD), in order to rapidly triage arterial lesions after penetrating trauma.

Methods: The presence of flow and the aspects of the Doppler waveform of the dorsalis pedis artery (DPA) and posterior tibial artery (PTA) of the injured lower limb (2PFD) were evaluated immediately before the execution of a standardized Color Duplex Doppler (SD) evaluation in 149 limbs of 140 patients with gunshot penetrating injuries. We considered 2PFD normal exams as the ones with triphasic patterns in both the DPA and PTA, and 2PFD pathologic exams as the ones with absent, biphasic, or monophasic flow patterns in the DPA and/or PTA. 2PFD data were then analyzed to assess accuracy variables, using SD results as matching test reference. According to the trauma center standard protocols, SD positive cases underwent also angiography and surgical exploration, whose findings were used to further match the 2PFD specificity.

Results: The 2PFD protocol showed a sensitivity of 100%, and a specificity of 100% compared with the SD, in the diagnostic workup of arterial injuries of the lower limbs after penetrating trauma. Furthermore, all the pathologic cases that resulted in all true positives (TP), compared with SD, were confirmed as TP also when matched with the angiography evaluation results.

Conclusions: The 2PFD protocol can rapidly identify arterial flow and differentiate between normal and pathologic spectral Doppler analyses in distal arteries. The presence of the normal triphasic flows in DPA and PTA is as sensitive as the standardized Color Doppler Duplex assessment of the entire limb in ruling out arterial lesions in lower-limb penetrating trauma. The absence of flow or the presence of a biphasic or monophasic pathologic flow in DPA and PTA is pathologic and should be always followed by further investigation. 2PFD is faster and easier to perform compared with the SD approach. It could become a new first-line screening technique, both in pre-hospital and hospital critical scenarios, particularly in contexts where advanced diagnostic performance is limited by time concerns or scarce resources.

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来源期刊
Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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