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病院前診療から繋ぐdirect CTの有用性と適応についての検討(Examination of the availability and indication of direct CT system lead to pre–hospital emergency medicine)

要旨【目的】全身CTから得られる情報は，重症外傷の治療戦略の決定に重要である。我々は病院前での診療結果から，重症外傷例では搬入時に全身CTを撮影する（以下direct CT）工夫を行ってきた。本戦略の有用性と適応を明らかにする。【対象】2010年4月から2017年1月の間に，病院前診療を行い体幹部緊急手術and/or血管塞栓術を要した88例をdirect CTの適応および実施の有無に分け，予後，時間，重症度等について比較した。【結果】18例が蘇生優先や手術室直入のためdirect CT適応外であった。残り70例のうち45例にdirect CTを実施し，根治的治療までの時間は実施群の方が早く（...

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Published in:	Nihon Kyūkyū Igakkai zasshi 2018-12, Vol.29 (12), p.749-757
Main Authors:	(Yuki Banshotani), 番匠谷友紀, (Tomohiro Hamagami), 濱上知宏, (Osamu Fujisaki), 藤崎修, (Hiroki Maeyama), 前山博輝, (Daisaku Matsui), 松井大作, (Makoto Kobayashi), 小林誠人
Format:	Article
Language:	English
Subjects:	infusion volume during PHEM severe truncal trauma whole-body CT 全身CT 病院前輸液重症体幹部外傷
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creator	(Yuki Banshotani), 番匠谷友紀 (Tomohiro Hamagami), 濱上知宏 (Osamu Fujisaki), 藤崎修 (Hiroki Maeyama), 前山博輝 (Daisaku Matsui), 松井大作 (Makoto Kobayashi), 小林誠人
description	要旨【目的】全身CTから得られる情報は，重症外傷の治療戦略の決定に重要である。我々は病院前での診療結果から，重症外傷例では搬入時に全身CTを撮影する（以下direct CT）工夫を行ってきた。本戦略の有用性と適応を明らかにする。【対象】2010年4月から2017年1月の間に，病院前診療を行い体幹部緊急手術and/or血管塞栓術を要した88例をdirect CTの適応および実施の有無に分け，予後，時間，重症度等について比較した。【結果】18例が蘇生優先や手術室直入のためdirect CT適応外であった。残り70例のうち45例にdirect CTを実施し，根治的治療までの時間は実施群の方が早く（実施群vs. 非実施群 = 62分vs. 78分，P
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Our hospital has been carrying out a direct CT system, in which patients are transported directly to the CT room if truncal injury is considered during pre–hospital emergency medicine (PHEM). The aim of this study was to evaluate availability of criteria for direct CT. Methods: After PHEM, 88 patients underwent emergency truncal operation and/or transcatheter arterial embolization from April 2010 to January 2017. We checked execution and indication for direct CT, and evaluated medical details relevant to severity, timeline and outcomes. Results: In total, 70 patients were indicated for direct CT, and this was carried out in 45 patients. The time from arrival to definitive therapy was earlier in the direct CT group (62min vs. 78min, P<0.01). The mortality was lower in the direct CT group [standardized mortality ratio (SMR) = 0.30, 95%CI 0.05–0.62] compared with the indirect CT group (SMR=0.61, 95%CI 0.17–1.36). 18 patients were not considered for direct CT because they needed immediate operation or resuscitation before CT, and the SMR was 0.37 (95%CI 0.11–0.80). Compared with direct CT patients, these patients presented with higher values of infusion volume (IV) and lower systolic blood pressure (sBP) during PHEM. The cut off point of IV was 695mL/h and sBP just before arrival was 94mmHg. Conclusion: These results showed that direct CT permit to start definitive therapy earlier and improve the survival rate. The patients who present sBP over 95mmHg before arrival result of resuscitation above 695mL/h of IV could execute direct CT.</description><identifier>ISSN: 1883-3772</identifier><identifier>EISSN: 1883-3772</identifier><identifier>DOI: 10.1002/jja2.12313</identifier><language>eng</language><subject>infusion volume during PHEM ; severe truncal trauma ; whole-body CT ; 全身CT ; 病院前輸液 ; 重症体幹部外傷</subject><ispartof>Nihon Kyūkyū Igakkai zasshi, 2018-12, Vol.29 (12), p.749-757</ispartof><rights>2018. Japanese Association for Acute Medicine. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c773-bb995cd08dbc9c1b20aa5f9c5607a481939f341f0e1a20634bbf35ea940d31b83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjja2.12313$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjja2.12313$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids></links><search><creatorcontrib>(Yuki Banshotani), 番匠谷友紀</creatorcontrib><creatorcontrib>(Tomohiro Hamagami), 濱上知宏</creatorcontrib><creatorcontrib>(Osamu Fujisaki), 藤崎修</creatorcontrib><creatorcontrib>(Hiroki Maeyama), 前山博輝</creatorcontrib><creatorcontrib>(Daisaku Matsui), 松井大作</creatorcontrib><creatorcontrib>(Makoto Kobayashi), 小林誠人</creatorcontrib><title>病院前診療から繋ぐdirect CTの有用性と適応についての検討(Examination of the availability and indication of direct CT system lead to pre–hospital emergency medicine)</title><title>Nihon Kyūkyū Igakkai zasshi</title><description>要旨【目的】全身CTから得られる情報は，重症外傷の治療戦略の決定に重要である。我々は病院前での診療結果から，重症外傷例では搬入時に全身CTを撮影する（以下direct CT）工夫を行ってきた。本戦略の有用性と適応を明らかにする。【対象】2010年4月から2017年1月の間に，病院前診療を行い体幹部緊急手術and/or血管塞栓術を要した88例をdirect CTの適応および実施の有無に分け，予後，時間，重症度等について比較した。【結果】18例が蘇生優先や手術室直入のためdirect CT適応外であった。残り70例のうち45例にdirect CTを実施し，根治的治療までの時間は実施群の方が早く（実施群vs. 非実施群 = 62分vs. 78分，P<0.01），標準化死亡比は0.30（95%CI 0.05–0.62）と0.61（95%CI 0.17–1.36）であった。direct CT適応外症例の標準化死亡比は0.37（95%CI 0.11–0.80）で，direct CT実施群と比較し病院前輸液量が多く血圧は低値で，カットオフ値は輸液量695mL/h，病院到着前の収縮期血圧94mmHgであった。【結語】direct CTは根治的治療までの時間を短縮し予後を改善する可能性があり，病院前診療で蘇生のための輸液を695mL/h以上要するが病院到着前血圧が95mmHg以上を満たす症例が適応となる。 ABSTRACT Background: Whole–body computed tomography (CT) is an important tool for severe trauma evaluation. Our hospital has been carrying out a direct CT system, in which patients are transported directly to the CT room if truncal injury is considered during pre–hospital emergency medicine (PHEM). The aim of this study was to evaluate availability of criteria for direct CT. Methods: After PHEM, 88 patients underwent emergency truncal operation and/or transcatheter arterial embolization from April 2010 to January 2017. We checked execution and indication for direct CT, and evaluated medical details relevant to severity, timeline and outcomes. Results: In total, 70 patients were indicated for direct CT, and this was carried out in 45 patients. The time from arrival to definitive therapy was earlier in the direct CT group (62min vs. 78min, P<0.01). The mortality was lower in the direct CT group [standardized mortality ratio (SMR) = 0.30, 95%CI 0.05–0.62] compared with the indirect CT group (SMR=0.61, 95%CI 0.17–1.36). 18 patients were not considered for direct CT because they needed immediate operation or resuscitation before CT, and the SMR was 0.37 (95%CI 0.11–0.80). Compared with direct CT patients, these patients presented with higher values of infusion volume (IV) and lower systolic blood pressure (sBP) during PHEM. The cut off point of IV was 695mL/h and sBP just before arrival was 94mmHg. Conclusion: These results showed that direct CT permit to start definitive therapy earlier and improve the survival rate. The patients who present sBP over 95mmHg before arrival result of resuscitation above 695mL/h of IV could execute direct CT.</description><subject>infusion volume during PHEM</subject><subject>severe truncal trauma</subject><subject>whole-body CT</subject><subject>全身CT</subject><subject>病院前輸液</subject><subject>重症体幹部外傷</subject><issn>1883-3772</issn><issn>1883-3772</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kMtKw0AYhYMoWKsbn2CWKrTOZNJclqV4KwU33YfJZKJTcilJULPriC6KKIKCFLqSohXBvSL4Lg619i20VoorV_9ZfOf88CnKMoJFBKG63mgQtYhUjPCMkkOmiQvYMNTZP3leWUiSBoS6buhaTnkd3pyOOreD9vln_2XYOZbiTB63h89nUly6PGY0BZW6FE8f3fbwuv_RupeiPxIPg7euFI9S9KQ4keJuDPS6n_2LlY0jEvCQpDwKQeSBdJ8BckC4Txzu8zQDJHQBD11Op8j0C0iyJGUB8BlxQRqBZszeW1f7UdLkKfEBC1i8x0KagYB993nIVheVOY_4CVv6vXmlvrlRr2wXartbO5VyrUANAxccx7JK1IWm61CLIkeFhJQ8i5Z0aBDNRBa2PKwhDzJEVKhjzXE8XGLE0qCLkWPivLI2maVxlCQx8-xmzAMSZzaC9li7PdZu_2j_htEEPuQ-y_4h7Wq1rE46X7ZTn9A</recordid><startdate>201812</startdate><enddate>201812</enddate><creator>(Yuki Banshotani), 番匠谷友紀</creator><creator>(Tomohiro Hamagami), 濱上知宏</creator><creator>(Osamu Fujisaki), 藤崎修</creator><creator>(Hiroki Maeyama), 前山博輝</creator><creator>(Daisaku Matsui), 松井大作</creator><creator>(Makoto Kobayashi), 小林誠人</creator><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>201812</creationdate><title>病院前診療から繋ぐdirect CTの有用性と適応についての検討(Examination of the availability and indication of direct CT system lead to pre–hospital emergency medicine)</title><author>(Yuki Banshotani), 番匠谷友紀 ; (Tomohiro Hamagami), 濱上知宏 ; (Osamu Fujisaki), 藤崎修 ; (Hiroki Maeyama), 前山博輝 ; (Daisaku Matsui), 松井大作 ; (Makoto Kobayashi), 小林誠人</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c773-bb995cd08dbc9c1b20aa5f9c5607a481939f341f0e1a20634bbf35ea940d31b83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>infusion volume during PHEM</topic><topic>severe truncal trauma</topic><topic>whole-body CT</topic><topic>全身CT</topic><topic>病院前輸液</topic><topic>重症体幹部外傷</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>(Yuki Banshotani), 番匠谷友紀</creatorcontrib><creatorcontrib>(Tomohiro Hamagami), 濱上知宏</creatorcontrib><creatorcontrib>(Osamu Fujisaki), 藤崎修</creatorcontrib><creatorcontrib>(Hiroki Maeyama), 前山博輝</creatorcontrib><creatorcontrib>(Daisaku Matsui), 松井大作</creatorcontrib><creatorcontrib>(Makoto Kobayashi), 小林誠人</creatorcontrib><collection>CrossRef</collection><jtitle>Nihon Kyūkyū Igakkai zasshi</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>(Yuki Banshotani), 番匠谷友紀</au><au>(Tomohiro Hamagami), 濱上知宏</au><au>(Osamu Fujisaki), 藤崎修</au><au>(Hiroki Maeyama), 前山博輝</au><au>(Daisaku Matsui), 松井大作</au><au>(Makoto Kobayashi), 小林誠人</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>病院前診療から繋ぐdirect CTの有用性と適応についての検討(Examination of the availability and indication of direct CT system lead to pre–hospital emergency medicine)</atitle><jtitle>Nihon Kyūkyū Igakkai zasshi</jtitle><date>2018-12</date><risdate>2018</risdate><volume>29</volume><issue>12</issue><spage>749</spage><epage>757</epage><pages>749-757</pages><issn>1883-3772</issn><eissn>1883-3772</eissn><abstract>要旨【目的】全身CTから得られる情報は，重症外傷の治療戦略の決定に重要である。我々は病院前での診療結果から，重症外傷例では搬入時に全身CTを撮影する（以下direct CT）工夫を行ってきた。本戦略の有用性と適応を明らかにする。【対象】2010年4月から2017年1月の間に，病院前診療を行い体幹部緊急手術and/or血管塞栓術を要した88例をdirect CTの適応および実施の有無に分け，予後，時間，重症度等について比較した。【結果】18例が蘇生優先や手術室直入のためdirect CT適応外であった。残り70例のうち45例にdirect CTを実施し，根治的治療までの時間は実施群の方が早く（実施群vs. 非実施群 = 62分vs. 78分，P<0.01），標準化死亡比は0.30（95%CI 0.05–0.62）と0.61（95%CI 0.17–1.36）であった。direct CT適応外症例の標準化死亡比は0.37（95%CI 0.11–0.80）で，direct CT実施群と比較し病院前輸液量が多く血圧は低値で，カットオフ値は輸液量695mL/h，病院到着前の収縮期血圧94mmHgであった。【結語】direct CTは根治的治療までの時間を短縮し予後を改善する可能性があり，病院前診療で蘇生のための輸液を695mL/h以上要するが病院到着前血圧が95mmHg以上を満たす症例が適応となる。 ABSTRACT Background: Whole–body computed tomography (CT) is an important tool for severe trauma evaluation. Our hospital has been carrying out a direct CT system, in which patients are transported directly to the CT room if truncal injury is considered during pre–hospital emergency medicine (PHEM). The aim of this study was to evaluate availability of criteria for direct CT. Methods: After PHEM, 88 patients underwent emergency truncal operation and/or transcatheter arterial embolization from April 2010 to January 2017. We checked execution and indication for direct CT, and evaluated medical details relevant to severity, timeline and outcomes. Results: In total, 70 patients were indicated for direct CT, and this was carried out in 45 patients. The time from arrival to definitive therapy was earlier in the direct CT group (62min vs. 78min, P<0.01). The mortality was lower in the direct CT group [standardized mortality ratio (SMR) = 0.30, 95%CI 0.05–0.62] compared with the indirect CT group (SMR=0.61, 95%CI 0.17–1.36). 18 patients were not considered for direct CT because they needed immediate operation or resuscitation before CT, and the SMR was 0.37 (95%CI 0.11–0.80). Compared with direct CT patients, these patients presented with higher values of infusion volume (IV) and lower systolic blood pressure (sBP) during PHEM. The cut off point of IV was 695mL/h and sBP just before arrival was 94mmHg. Conclusion: These results showed that direct CT permit to start definitive therapy earlier and improve the survival rate. The patients who present sBP over 95mmHg before arrival result of resuscitation above 695mL/h of IV could execute direct CT.</abstract><doi>10.1002/jja2.12313</doi><tpages>9</tpages></addata></record>
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source	Wiley Online Library Journals Frontfile Complete
subjects	infusion volume during PHEM severe truncal trauma whole-body CT 全身CT 病院前輸液重症体幹部外傷
title	病院前診療から繋ぐdirect CTの有用性と適応についての検討(Examination of the availability and indication of direct CT system lead to pre–hospital emergency medicine)
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