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Master Thesis

L’intuition clinique permet-elle de prédire la présence de lésion grave au scanner chez les patients stables suspects d’un traumatisme sévère à haute cinétique ? Une étude prospective, observationnelle au CHU de Grenoble sur un an

Abstract : Introduction: For severe trauma patients, the initial assessment is critical to guide the treatment. The whole body scanner (WBS) is widely used for lesion assessment. The aim of this study was to assess the performance of the clinical sense of physicians and the clinical examination to predict the existence of a serious injury for particular subclass of patients with suspected severe trauma on high kinetic arguments but clinically stable. Materials and Methods: This prospective observational study was conducted in a " Level 1 trauma center " from June 2014 to June 2015. The physician was asked to judge the probability of serious injury after examining the patient. Intuition and then physical examination were compared to the presence of serious lesions defined by an Abbreviated Injury Score ≥3 in the CT-scan assesment. Results and Discussion: 367 patients were enrolled. 269 patients were men. The average age was 39. The average score NISS (New Injury Severity Score) was 9 ± 11. Conclusion: The practitioner’s clinical intuition can’t be relied upon to determine the indication of SCE with a significant risk of undiagnosed occult lesions. In contrast, a strictly The diagnostic performance of clinical intuition was poor with an area under the curve (AUC) of the ROC curve equal to 0.696 [0.64 to 0.75], sensitivity of 82.2% [74.1% -88.6 %] and specificity of 48.6% [41.9% -55.4%]. The positive predictive value (PPV) was 38.4% [29.4% - 48.1%], the negative predictive value (NPV) of 83.6% [76% - 89.5%] corresponding to 16 4% occult lesions. The diagnostic performance of physical exam was also poor (AUC = 0.534 [0.51 to 0.56]) but the general clinical examination NPV was excellent (100% [82.4% - 100%]) as the head’s examination NPV (100% [97.8% -100%]). Conclusion: The practitioner’s clinical intuition can’t be relied upon to determine the indication of SCE with a significant risk of undiagnosed occult lesions. In contrast, a strictly normal physical examination seems enough to eliminate the presence of serious lesions in this population. Similarly, at brain level, in the absence of clinical and anamnestic argument no injury is expected.
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Master Thesis
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Submitted on : Tuesday, July 26, 2016 - 2:28:22 PM
Last modification on : Wednesday, July 15, 2020 - 8:58:04 AM

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Vivien Brenckmann. L’intuition clinique permet-elle de prédire la présence de lésion grave au scanner chez les patients stables suspects d’un traumatisme sévère à haute cinétique ? Une étude prospective, observationnelle au CHU de Grenoble sur un an . Médecine humaine et pathologie. 2016. ⟨dumas-01348980⟩

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