科研之友
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摘要
Objective: Occupants in high-speed motor vehicle collisions often show subcutaneous adipose tissue enhancement on 3D reconstruction CTs that appears consistent with the path of the seat belt. These subcutaneous adipose beltmarks (SABs) may aid in clinical and biomechanical research. The goal of this project was to provide an initial proof-of-concept for SAB identification. This was achieved by determining the level of agreement between locations of SAB and visible injury. A secondary objective was to determine if independent evaluators agreed on the presence and location of SABs.
Methods: A retrospective study was performed using the Crash Injury Research and Engineering Network (CIREN) database to select cases with external trauma from seat belt use in frontal impact collisions. The inclusion criteria were high-speed (>40 kph), frontal impact, occupants age >= 15 years, seat belt in use, patient photos showing abdominal bruising, and abdominal CT DICOMs available. For each case, patient photos and CT 3D reconstructions with fat enhancement were de-identified. The location of suspected seat belt injuries on photos andCT renderings were described using a newly-designed metric, which divided the abdomen into four zones. Two medical doctors evaluated each image independently. Inter-rater reliability was calculated separately for photos and CT renderings. When disagreement over location existed, the image was discussed and a consensus was achieved. The location of the visible injury was then compared to the location of the SABs for each case to determine agreement.
Results: Twenty-two CIREN cases met the inclusion criteria. The 3D renderings of the fat-enhanced CTs revealed subcutaneous enhancement consistent with a SABin 20 of 22 cases (95%). Evaluators agreed on the location of injury based on photos in 19/22 cases (86%, kappa 0.72) and CT renderings in cases 21/22 (95%, kappa 0.93) of cases. Within the group containing SABs, 15 of 20 (75%, kappa 0.56) casesmatched the location of the SAB to the same zone as the visible seat belt mark. In one instance, the SAB was one zone inferior to the visible mark, while the SAB in four cases was one zone superior. Injuries were in the same or adjacent zones in all cases when a SAB was identified.
Conclusions: SABs identified on fat-enhanced 3D reconstructions abdominal CT were shown to be correlated with visible seat belt injuries. This study indicated SABs may be caused by subcutaneous injury by compression from the seat belt during frontal impact motor vehicle collisions. Further investigation correlating SABs with intra-abdominal injury and sensitivity/specificity analysis is warranted.
- 出版日期2014-9-26
