Travmada tüm vücut bilgisayarlı tomografi taramasının tanısal yararı
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Tarih
2025
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Yayıncı
Alanya Alaaddin Keykubat Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Amaç: Bu çalışmanın amacı, tüm vücut bilgisayarlı tomografinin (TVBTT) travma hastalarında tanısal etkinliğini belirlemek, görüntüleme endikasyonlarının uygunluğunu analiz etmek ve bu verilerin hastane sonlanımları üzerindeki etkisini değerlendirmektir. Ayrıca TVBTT'nin gereksiz kullanım oranını ve klinik karar süreçlerine katkısını irdelemek amaçlanmıştır. Yöntem: Bu retrospektif tanımlayıcı çalışma, Ocak 2024 – Temmuz 2024 tarihleri arasında üçüncü basamak bir eğitim ve araştırma hastanesinin acil servisine başvuran ve TVBTT uygulanan 531 erişkin travma hastasını kapsamaktadır. Hastalar, travma mekanizması (yüksek vs. düşük enerjili), BT endikasyonu varlığı, radyolojik bulgu durumu, laboratuvar verileri (WBC, laktat), vital bulgular ve hastane sonlanımı (YBÜ yatışı, entübasyon, mortalite) açısından değerlendirilmiştir. BT sonuçları pozitif/negatif olarak sınıflandırılmış; çok değişkenli lojistik regresyon analizi ile BT pozitifliğini öngören faktörler belirlenmiştir. Tanısal verimlilik, endikasyon uygunluğu ve sonlanım ilişkileri istatistiksel olarak karşılaştırılmıştır (p<0.05 anlamlı kabul edilmiştir). Bulgular: Değerlendirilen 531 hastanın 296'sında (%55,7) en az bir pozitif BT bulgusu saptanmıştır. Yüksek enerjili travma geçiren 288 hastanın 224'ünde (%77,8), düşük enerjili travmalı 243 hastanın ise yalnızca 68'inde (%28) BT pozitifliği izlenmiştir (p<0.001). Endikasyon kriterleri dışında BT uygulanan 192 hastanın 113'ünde (%58,9) herhangi bir patoloji saptanmamıştır. Pozitif BT grubunda toraks travması (%27,9), kafa travması (%19,0), batın içi organ yaralanması (%17,5) ve vertebra kırığı (%13,4) en sık saptanan VII bulgulardır. BT ile saptanan "sessiz yaralanmalar" 122 hastada izlenmiş ve bunların 47'sinde (%38,5) tedavi stratejisi değiştirilmiştir. Lojistik regresyon analizinde yaş (OR: 1.030; p=0.001), laktat düzeyi (OR: 2.939; p=0.040) ve WBC (OR: 1.080; p=0.021), pozitif BT ile anlamlı ilişkili bulunmuştur. Pozitif BT grubunda YBÜ yatışı (%24,3) ve hastane içi mortalite oranı (%5,1), negatif gruba göre anlamlı olarak daha yüksektir (p<0.05). Sonuç: TVBTT, travma hastalarında özellikle yüksek enerjili mekanizmaya sahip olgularda yüksek tanısal doğrulukla kritik yaralanmaları ortaya koymakta ve klinik karar süreçlerini anlamlı şekilde yönlendirmektedir. Ancak, çalışmada endikasyon dışı TVBTT oranının %36,1 düzeyinde olması ve bu hastaların çoğunda pozitif bulgu saptanmaması, gereksiz radyasyon yükü ve kontrast kaynaklı riskler açısından dikkate değerdir. Klinik muayene, travma mekanizması ve biyobelirteçlerin birlikte değerlendirilmesi ile geliştirilecek seçici BT algoritmaları sayesinde tanısal etkinlik artırılabilir, kaynak israfı ve hasta maruziyeti azaltılabilir. Bu bağlamda, ATLS, ACS-TQIP ve REACT-2 gibi kılavuzlara uygun, çok parametreli, algoritmik görüntüleme protokollerinin klinik pratiğe entegrasyonu önerilmektedir. Anahtar Kelimeler: Travma, Tüm vücut BT, WBCT, Multitravma, Travma Görüntüleme, Travma Laktat, Yaralanma Dağılım, Acil Servis Travma Görüntüleme.
Objective: This study aimed to evaluate the diagnostic utility of whole-body computed tomography (WBCT) in trauma patients, to assess the appropriateness of imaging indications, and to investigate the impact of WBCT findings on clinical outcomes. Furthermore, the study sought to identify the rate of unnecessary WBCT applications and its influence on clinical decision-making. Methods: This retrospective descriptive study included 531 adult trauma patients who presented to the emergency department of a tertiary trauma center between January 2024 and July 2024 and underwent WBCT. Patients were assessed based on trauma mechanism (high vs. low-energy), presence of WBCT indication, radiologic findings (positive/negative), laboratory parameters (WBC, lactate), vital signs, and hospital outcomes (ICU admission, intubation, mortality). A multivariate logistic regression model was used to determine predictive factors for positive CT findings. Statistical significance was set at p<0.05. Results: Of the 531 patients, 296 (55.7%) had at least one positive radiological finding. Among patients exposed to high-energy trauma (n=288), 224 (77.8%) had positive CT results, compared to only 68 (28%) in the low-energy trauma group (p<0.001). In 192 patients (36.1%) WBCT was performed without indication, and 113 (58.9%) of these scans yielded negative results. The most common injuries were thoracic trauma (27.9%), head trauma (19.0%), intra-abdominal injuries (17.5%), and vertebral fractures (13.4%). "Occult injuries" not detected by physical examination were found in 122 patients, 47 of whom IX (38.5%) underwent a change in management based on CT findings. Age (OR: 1.030; p=0.001), lactate (OR: 2.939; p=0.040), and WBC count (OR: 1.080; p=0.021) were independently associated with positive CT results. ICU admission (24.3%) and in-hospital mortality (5.1%) rates were significantly higher in the positive WBCT group compared to negative ones (p<0.05). Conclusion: WBCT provides high diagnostic accuracy in the evaluation of trauma patients, particularly in those exposed to high-energy mechanisms, and plays a crucial role in clinical decision-making. However, the 36.1% rate of non-indicated scans— predominantly among younger patients with low-risk trauma—highlights concerns regarding unnecessary radiation exposure and contrast-related risks. Integrating clinical findings, trauma mechanism, and biomarkers such as lactate and WBC into selective CT decision algorithms could enhance diagnostic precision while minimizing risk and resource burden. Therefore, clinical protocols should be restructured in alignment with international guidelines such as ATLS, ACS-TQIP, and REACT-2, emphasizing a multiparametric and patient-centered approach to imaging in trauma care. Keywords: Trauma, Whole-body CT, WBCT, Polytrauma, Trauma Imaging, Trauma Lactate, Injury Distribution, Emergency Department Trauma Imaging.
Objective: This study aimed to evaluate the diagnostic utility of whole-body computed tomography (WBCT) in trauma patients, to assess the appropriateness of imaging indications, and to investigate the impact of WBCT findings on clinical outcomes. Furthermore, the study sought to identify the rate of unnecessary WBCT applications and its influence on clinical decision-making. Methods: This retrospective descriptive study included 531 adult trauma patients who presented to the emergency department of a tertiary trauma center between January 2024 and July 2024 and underwent WBCT. Patients were assessed based on trauma mechanism (high vs. low-energy), presence of WBCT indication, radiologic findings (positive/negative), laboratory parameters (WBC, lactate), vital signs, and hospital outcomes (ICU admission, intubation, mortality). A multivariate logistic regression model was used to determine predictive factors for positive CT findings. Statistical significance was set at p<0.05. Results: Of the 531 patients, 296 (55.7%) had at least one positive radiological finding. Among patients exposed to high-energy trauma (n=288), 224 (77.8%) had positive CT results, compared to only 68 (28%) in the low-energy trauma group (p<0.001). In 192 patients (36.1%) WBCT was performed without indication, and 113 (58.9%) of these scans yielded negative results. The most common injuries were thoracic trauma (27.9%), head trauma (19.0%), intra-abdominal injuries (17.5%), and vertebral fractures (13.4%). "Occult injuries" not detected by physical examination were found in 122 patients, 47 of whom IX (38.5%) underwent a change in management based on CT findings. Age (OR: 1.030; p=0.001), lactate (OR: 2.939; p=0.040), and WBC count (OR: 1.080; p=0.021) were independently associated with positive CT results. ICU admission (24.3%) and in-hospital mortality (5.1%) rates were significantly higher in the positive WBCT group compared to negative ones (p<0.05). Conclusion: WBCT provides high diagnostic accuracy in the evaluation of trauma patients, particularly in those exposed to high-energy mechanisms, and plays a crucial role in clinical decision-making. However, the 36.1% rate of non-indicated scans— predominantly among younger patients with low-risk trauma—highlights concerns regarding unnecessary radiation exposure and contrast-related risks. Integrating clinical findings, trauma mechanism, and biomarkers such as lactate and WBC into selective CT decision algorithms could enhance diagnostic precision while minimizing risk and resource burden. Therefore, clinical protocols should be restructured in alignment with international guidelines such as ATLS, ACS-TQIP, and REACT-2, emphasizing a multiparametric and patient-centered approach to imaging in trauma care. Keywords: Trauma, Whole-body CT, WBCT, Polytrauma, Trauma Imaging, Trauma Lactate, Injury Distribution, Emergency Department Trauma Imaging.
Açıklama
30.04.2026 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır.
Anahtar Kelimeler
Acil Tıp, Emergency Medicine
