PMID- 31351577
OWN - NLM
STAT- MEDLINE
DCOM- 20200226
LR  - 20200226
IS  - 1879-1883 (Electronic)
IS  - 0002-9610 (Linking)
VI  - 218
IP  - 4
DP  - 2019 Oct
TI  - Is clinician assessment accurate or is routine pan-body CT needed in the stable 
      intoxicated trauma patient?
PG  - 755-759
LID - S0002-9610(19)30105-9 [pii]
LID - 10.1016/j.amjsurg.2019.07.010 [doi]
AB  - BACKGROUND: We sought to determine if clinician suspicion of injury was useful in 
      predicting injuries found on pan-body computed tomography (PBCT) in clinically 
      intoxicated patients. METHODS: We prospectively enrolled awake, intoxicated 
      patients with low-energy mechanism of injury. For each of four body regions 
      (head/face, neck, thorax and abdomen/pelvis), clinician suspicion for injury was 
      recorded as "low index" or "more than a low index". The reference standard was 
      the presence of any pre-defined significant finding (SF) on CT. Sensitivity, 
      specificity, positive (LR+) and negative (LR-) likelihood ratios were calculated. 
      RESULTS: Enrollment of 103 patients was completed. Sensitivity, specificity, LR+ 
      and LR-for clinician index of suspicion were: 56%, 68%, 1.75, 0.64 (head/face), 
      50%, 92%, 6.18, 0.54 (neck), 10%, 96%, 2.60, 0.94 (thorax) and 67%, 93%, 9.56, 
      0.36 (abdomen/pelvis). CONCLUSION: Clinician judgement was most useful to guide 
      need for CT imaging in the neck and abdomen/pelvis. Routine PBCT may not be 
      necessary. SUMMARY: For awake, stable intoxicated patients after falls and 
      assaults, clinician index of suspicion was most useful to guide the need for CT 
      imaging in the neck and abdomen/pelvis. Our findings support selective use of CT 
      if the index of suspicion is low. Routine PBCT may not be necessary.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Foster, Shannon Marie
AU  - Foster SM
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States. 
      Electronic address: Shannon.foster@towerhealth.org.
FAU - Muller, Alison
AU  - Muller A
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States.
FAU - Conklin, Jeremy
AU  - Conklin J
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States.
FAU - Cortes, Vicente
AU  - Cortes V
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States.
FAU - Fernandez, Forrest B
AU  - Fernandez FB
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States.
FAU - Geng, Thomas A Jr
AU  - Geng TA Jr
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States.
FAU - Reilly, Eugene F
AU  - Reilly EF
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States.
FAU - Sigal, Adam
AU  - Sigal A
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States.
FAU - Ong, Adrian W
AU  - Ong AW
AD  - Reading Trauma Center, Reading Hospital, Tower Health System, United States.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190717
PL  - United States
TA  - Am J Surg
JT  - American journal of surgery
JID - 0370473
SB  - IM
MH  - Accidental Falls
MH  - Adult
MH  - Alcoholic Intoxication/*complications/*diagnostic imaging
MH  - *Clinical Competence
MH  - *Clinical Decision-Making
MH  - Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - *Tomography, X-Ray Computed
MH  - Violence
MH  - Wounds, Nonpenetrating/*diagnostic imaging/etiology
OTO - NOTNLM
OT  - Clinical judgement
OT  - Computed tomography
OT  - Intoxicated falls
OT  - Low energy trauma
OT  - Suspicion of injury
EDAT- 2019/07/29 06:00
MHDA- 2020/02/27 06:00
CRDT- 2019/07/29 06:00
PHST- 2019/03/01 00:00 [received]
PHST- 2019/05/07 00:00 [revised]
PHST- 2019/07/16 00:00 [accepted]
PHST- 2019/07/29 06:00 [pubmed]
PHST- 2020/02/27 06:00 [medline]
PHST- 2019/07/29 06:00 [entrez]
AID - S0002-9610(19)30105-9 [pii]
AID - 10.1016/j.amjsurg.2019.07.010 [doi]
PST - ppublish
SO  - Am J Surg. 2019 Oct;218(4):755-759. doi: 10.1016/j.amjsurg.2019.07.010. Epub 2019 
      Jul 17.