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J Crit Care. 2017 Feb;37:211-218. doi: 10.1016/j.jcrc.2016.10.003. Epub 2016 Oct 12.

The clinical benefit of a follow-up thoracic computed tomography scan regarding parenchymal lung injury and acute respiratory distress syndrome in polytraumatized patients.

Author information

1
Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. Electronic address: lukas.negrin@meduniwien.ac.at.
2
Department of Radiology and Nuclear Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. Electronic address: helmut.prosch@meduniwien.ac.at.
3
Department of Anesthesiology, General Intensive Care and Pain Management, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. Electronic address: stephan.kettner@meduniwien.ac.at.
4
Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. Electronic address: gabriel.halat@meduniwien.ac.at.
5
Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. Electronic address: thomas.heinz@meduniwien.ac.at.
6
Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. Electronic address: stefan.hajdu@meduniwien.ac.at.

Abstract

PURPOSE:

To evaluate the increase of parenchymal lung injury (PLI) volume between the initial and a follow-up computed tomography (CT) scan and to ascertain which of the 2 scans was more appropriate to predict acute respiratory distress syndrome (ARDS).

MATERIAL AND METHODS:

From 2011 to 2015, polytraumatized patients (≥18 years; ISS ≥ 16) directly admitted to our level I trauma center were included in our prospective study if a follow-up CT scan was possible 24 to 48 hours after the trauma. The PLI volume was measured using volumetric analysis. Statistical calculations were performed to identify patients at risk for ARDS.

RESULTS:

One hundred thirty patients (mean age, 41.3 years; mean ISS, 31.9) met the inclusion criteria. Median relative PLI volume was higher in the follow-up than in the initial CTs (9.65% vs 4.84%; P = .001). The ARDS developed in 42 patients (32.3%). Their initial PLI volume was higher compared with those without ARDS (11.23% vs 2.14%; P < .0001). The ARDS incidence increased with increasing initial PLI volume. Receiver operating characteristic statistics identified initial (area under the curve = 0.753) and follow-up relative PLI volume as a predictor for ARDS (area under the curve = 0.725).

CONCLUSIONS:

The CT scans performed directly after admission are sufficient to define patients at risk for ARDS. Therefore, solely the incidence of PLI does not justify a routine follow-up CT scan.

KEYWORDS:

ARDS; Follow-up CT scan; Parenchymal lung injury; Polytraumatized patients; Volumetric analysis

PMID:
27969573
DOI:
10.1016/j.jcrc.2016.10.003
[Indexed for MEDLINE]

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