gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

The influence of initial assessment with x-rays versus whole-body computed tomography on complications: a retrospective cohort study of seriously injured patients with pelvic trauma

Meeting Abstract

  • presenting/speaker Thorsten Jentzsch - UniversitätsSpital Zürich, Zürich, Switzerland
  • Kai Sprengel - UniversitätsSpital Zürich, Zürich, Switzerland
  • Lucas Kutschke - UniversitätsSpital Zürich, Zürich, Switzerland
  • Tanja Haller - UniversitätsSpital Zürich, Zürich, Switzerland
  • Ulrike Held - Horten Zentrum, Universität Zürich, Zürich, Switzerland
  • Hans-Peter Simmen - UniversitätsSpital Zürich, Zürich, Switzerland
  • Guido A. Wanner - UniversitätsSpital Zürich, Zürich, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO18-937

doi: 10.3205/17dkou710, urn:nbn:de:0183-17dkou7109

Veröffentlicht: 23. Oktober 2017

© 2017 Jentzsch et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Pelvic trauma is associated with high mortality. Initial imaging is shifting from x-rays to whole-body computed tomography (WBCT) to obtain more accurate diagnoses. The aim of this study was to investigate whether initial imaging influences the occurrence of complications in seriously injured patients with pelvic trauma.

Methods: This retrospective cohort study investigated consecutive, seriously injured patients (abbreviated injury scale (AIS) of ≥3) with pelvic trauma at a level one trauma center. The main exposure variable was initial assessment with x-rays and sonography (2004-2006; group 1) versus (vs) WBCT (2010-2012; group 2) (Figure 1 [Fig. 1]). The primary outcome variable was the occurrence of a complication. There were several secondary exposures and outcomes, such as time in resuscitation room. Confounders were adjusted for in a logistic regression model and consisted of sex, age, injury severity score (ISS), advanced trauma life support (ATLS) shock classification (hemodynamically unstable if ≥2), pelvic fracture type, revised trauma score, Marshall score, acute physiology and chronic health evaluation II (APACHE II) score, and hematocrit.

Results and Conclusion: This study included 132 patients, 62.12% males, and a median age of 45.00 (IQR 31.50-60.00) years. In group 1, 88.71% received a CT later on. The complication rate did not differ in both groups (77.42 (group 1) vs 75.71% (groups 2); p=0.82). There were no differences in the death rate either (27.42 vs 25.71%, p=0.83. The resuscitation room time was lower in group 1 (90.00 vs 100.00 minutes; p=0.033). After adjusting for confounders, no association between groups and the occurrence of a complication remained (adjusted odds ratio (ORadjusted)=1.45, 95% confidence interval (CI) 0.47-4.54; p=0.52) (Table 1 [Tab. 1]). The Marshall score was the only exposure variable that continued to be associated with more complications (ORadjusted=1.32, 95% CI 1.08-1.61; p=0.007).

In this study of seriously injured patients with pelvic trauma, the initial assessment with x-rays versus WBCT did not influence the complication or death rate although the resuscitation room time was ten minutes longer; independently of the hemodynamic status. However, this could potentially be attributed to the use of CT in the course of disease. Therefore, both initial imaging options seem to be valid. Higher Marshall scores were independently associated with more complications and seem to be a good predictor of morbidity.