Max R. Van Diepen, Mathieu M. E. Wijffels, Michael H. J. Verhofstad, Esther M. M. Van Lieshout
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引用次数: 0
摘要
导言肺挫伤(PC)患者出现并发症和长期呼吸困难的风险较高。计算机断层扫描(CT)对肺挫伤的敏感性很高。然而,由于肺挫伤会随着时间的推移而发展,因此在创伤后直接进行的 CT 扫描可能会低估肺挫伤的全部程度。因此需要更好地确定哪些 PC 患者更容易出现并发症。本系统性综述旨在确定 PC 的不同分类系统,并研究 PC 的数量与院内预后之间的关系。方法根据 PRISMA 指南进行了系统性回顾,纳入了基于 CT 扫描对胸部钝性创伤后 PC 分类系统进行报告的研究。结果共纳入 20 项研究。患者总数从 49 人到 148140 人不等。最常用的分类系统是计算挫伤肺容积的百分比。其他分类方法基于钝性肺挫伤评分-6 和-18、简略损伤评分和胸部创伤严重程度评分。较差的结果通常与 18% 至 24% 的挫伤量有关。最常见的 PC 分类方法是基于体积分析。与使用 BPC-6、BPC-18 或 AIS 相比,计算 PC 占总体积的百分比可实现最高水平的肺实质分割。一般来说,挫伤体积超过 18-24% 的患者预后较差。
Classification methods of pulmonary contusion based on chest CT and the association with in-hospital outcomes: a systematic review of literature
Introduction
Patients sustaining pulmonary contusion (PC) have a higher risk of complications and long-term respiratory difficulty. Computed tomography (CT) scans have a high sensitivity for PC. However, since PC develops over time, CT scans made directly post-trauma may underestimate the full extent of PC. This creates a need to better define in which PC-patients complications are more likely. The aim of this systematic review was to identify different classification systems of PC, and investigate the association between amount of PC and in-hospital outcomes.
Methods
A systematic review was conducted in accordance with PRISMA guidelines. Studies reporting a classification system for PC after blunt thoracic trauma based on a CT scan were included. Outcomes were classification method of PC and the relation between classification and pulmonary complications and in-hospital outcomes.
Results
Twenty studies were included. Total number of patients ranged from 49 to 148,140 patients. The most common classification system used was calculating the percentage of contused lung volume. Other classification methods were based on Blunt Pulmonary Contusion score-6 and -18, Abbreviated Injury Score and Thoracic Trauma Severity scores. Worse outcomes were generally associated with between > 18 to > 24% contusion volume.
Discussion
The heterogeneity of currently available literature makes comparing classification methods challenging. The most common classification of PC was based on volumetric analysis. Calculating a percentage of PC as part of the total volume allows for the highest level of segmentation of lung parenchyma as compared to using BPC-6, BPC-18, or AIS. Contusion volume exceeding 18–24% was generally associated with worse outcomes.
期刊介绍:
The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries.
Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.