下腔静脉容积的预后意义由最初的多发性创伤 CT 成像确定:一家一级创伤中心的单中心经验。

IF 2 Q2 EMERGENCY MEDICINE
Hans-Jonas Meyer, Veronika Sotikova, Michael Hetz, Georg Osterhoff, Christian Kleber, Timm Denecke, Robert Werdehausen, Gunther Hempel, Manuel F Struck
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引用次数: 0

摘要

背景:基于计算机断层扫描(CT)的下腔静脉(IVC)容积测量在创伤患者的治疗和预后中的意义尚未完全明了。已报道的结果相互矛盾,这可能是由于损伤严重程度不同以及使用了不同的测量方法,包括 IVC 指数和容积测量法。本研究的目的是确定插管创伤患者的 IVC 容量和红细胞(RBC)输注与死亡率之间的关系,这些患者的病情足够稳定,可以进行初始 CT 成像检查:我们对一家一级创伤中心 12 年内(2008-2019 年)所有在初次全身 CT 成像前进行紧急气管插管和机械通气的连续创伤患者进行了回顾性分析。最初的创伤 CT 确定了 IVC 容量,并将其与人口统计学和诊断数据一起纳入多变量模型。使用逻辑回归分析和Cox比例危险模型评估了整体RBC输注、大量输血、24小时死亡率和30天死亡率的相关性:共有 438 名患者(75.3% 为男性)参与了分析,他们的中位年龄为 50 岁,受伤严重程度评分(ISS)中位数为 26 分。大多数患者(97.5%)遭受过钝伤。中位 IVC 容量为 36.25 立方厘米,分别为 197 名和 90 名患者输注了红细胞和大量输血。24 天和 30 天的死亡率分别为 7.3% 和 23.3%。研究发现,VCI容积与是否需要输注红细胞和24小时死亡率独立相关(OR分别为0.98,95% CI为0.96-0.99,p = 0.01;HR分别为0.96,95% CI为0.93-0.99,p = 0.025),而在多变量分析中,与大量输血和30天死亡率的相关性无统计学意义:结论:初始 IVC 容量可作为预测患者整体 RBC 输血需求和 24 小时死亡率风险的指标,这表明其在短期结果中可能具有诊断功效。需要进一步的研究来证实这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic significance of inferior vena cava volume defined by initial polytrauma CT-imaging: single-center experience of a level-1 trauma center.

Background: The significance of computed tomography (CT)-based volume measurement of the inferior vena cava (IVC) in the treatment and prognosis of trauma patients is not yet fully understood. The conflicting results that have been reported may be attributable to differences in injury severity and the use of different measurement methods, including IVC index and volumetry. The purpose of this study was to determine the relationship between IVC volume and red blood cell (RBC) transfusion and mortality in intubated trauma patients who were stable enough for initial CT imaging.

Methods: A retrospective analysis was conducted on all consecutive trauma patients who underwent emergency tracheal intubation and mechanical ventilation before initial whole-body CT imaging at a level-1 trauma center over a 12-year period (2008-2019). The IVC volume was determined on initial trauma CT and included in multivariable models with demographic and diagnostic data. Associations of overall RBC transfusion, massive transfusion, 24-h mortality, and 30-day mortality were assessed using logistic regression analyses and Cox proportional hazard models.

Results: A total of 438 patients (75.3% male) with a median age of 50 years, and a median injury severity score (ISS) of 26 points were included in the analysis. Most of the patients (97.5%) had suffered from blunt trauma mechanisms. Median IVC volume was 36.25 cm3, and RBC transfusion and massive transfusion were performed in 197 and 90 patients, respectively. The 24-h and 30-day mortality rates were 7.3% and 23.3%, respectively. VCI volume was found to be independently associated with the necessity of RBC transfusion and 24-h mortality (OR 0.98, 95% CI 0.96-0.99, p = 0.01 and HR 0.96, 95% CI 0.93-0.99, p = 0.025, respectively), while associations with massive transfusion and 30-day mortality were not statistically significant in multivariable analyses.

Conclusion: Initial IVC volume may serve as a predictor of patients at risk for overall RBC transfusion requirements and 24-h mortality, suggesting the possibility of its diagnostic efficacy in short-term outcomes. Further studies are needed to confirm these findings.

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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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