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둔상성 신외상에서 일차적 방사선 검사법으로서의 전산화단층촬영술의 적정성
박용주,이종복,이재환,견중기 대한외상학회 2001 大韓外傷學會誌 Vol.14 No.1
Purpose: This study aimed to evaluate the costeffectiveness of computerized tomography (CT) as a primary radiographic investigation for patients with blunt renal trauma who meet the criteria for radiographic assessment. Method: From June 1993 to December 2000, all the patients who visited the emergency center due to blunt abdominal trauma with gross or microscopic hematuria except adults presented with microhematuria, no cases of shock were included in this study, and abdominal CT was performed as a routine radiographic study. Renal injuries were classified into 5 grades using the Moore's classification according to the results of CT findings and the efficacy of CT as a primary radiographic investigation was evaluated. Results: A total of 178 patients (34 children and 144 adults) met the criteria of our study. Of the 178 patients, 77 (43.3%), were classified as grade I 37 (20.8%) as grade II, 26 (14.6%) as grade III, 30 (16.9%) as grade IV, and 8 (4.5%) as grade V. Associated intra-abdominal organ injuries were detected in 32 (18%) patients. The rate of major renal injuries (grade Ⅲ-Ⅴ), which were considered to need CT as a radiographic study, was 36%. Thirty-two (18%) patients under-went operative treatment, and the grade between preoperative and intraoperative findings was identical in all patients. Conclusion: The results of this study show that CT should be performed for at least one-third of the patients with blunt renal trauma. When a radiographic study is indicated, we recommend CT as a primary diagnostic investigation instead of IVP.