The use of chest computed tomography versus chest X-ray in patients with major blunt trauma

      Summary

      Introduction

      Computed tomography (CT) scans are often used in the evaluation of patients with blunt trauma. This study identifies the clinical features associated with further diagnostic information obtained on a CT chest scan compared with a standard chest X-ray in patients sustaining blunt trauma to the chest.

      Methods

      A 2-year retrospective survey of 141 patients who attended a Level 1 trauma centre for blunt trauma and had a chest CT scan and a chest X-ray as part of an initial assessment was undertaken. Data extracted from the medical record included vital signs, laboratory findings, interventions and the type and severity of injury.

      Results

      The CT chest scan is significantly more likely to provide further diagnostic information for the management of blunt trauma compared to a chest X-ray in patients with chest wall tenderness (OR = 6.73, 95% CI = 2.56, 17.70, p < 0.001), reduced air-entry (OR = 4.48, 95% CI = 1.33, 15.02, p = 0.015) and/or abnormal respiratory effort (OR = 4.05, 95% CI = 1.28, 12.66, p = 0.017). CT scan was significantly more effective than routine chest X-ray in detecting lung contusions, pneumothoraces, mediastinal haematomas, as well as fractured ribs, scapulas, sternums and vertebrae.

      Conclusion

      In alert patients without evidence of chest wall tenderness, reduced air-entry or abnormal respiratory effort, selective use of CT chest scanning as a screening tool could be adopted. This is supported by the fact that most chest injuries can be treated with simple observation. Intubated patients, in most instances, should receive a routine CT chest scan in their first assessment.

      Keywords

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      References

        • Hekir M.D.
        • Hollands M.J.
        • Deane S.A.
        The accuracy of the first chest X-ray in the trauma patient.
        ANZ J Med Surg. 1990; 60: 529-532
        • Johnson J.A.
        • Cogbill T.H.
        • Winga E.R.
        Determinants of outcome after pulmonary contusion.
        J Trauma. 1986; 26: 695-697
        • Karaaslan T.
        • Meuli R.
        • Androux R.
        • et al.
        Traumatic chest lesions in patients with severe head trauma: a comparative study with computed tomography and conventional chest roentgenograms.
        J Trauma. 1995; 39: 1081-1086
        • Kulshrestha P.
        • Munshi I.
        • Wait R.
        Profile of chest trauma in a level I trauma center.
        J Trauma. 2004; 57: 576-581
        • LoCicero III, J.
        • Mattox K.L.
        Epidemiology of chest trauma.
        Surg Clin N Am. 1989; 69: 15-19
        • Marts B.
        • Durham R.
        • Shapiro M.
        • et al.
        Computed tomography in the diagnosis of blunt thoracic injury.
        Am Surg. 1994; 168: 688-692
        • Pinilla J.C.
        Acute respiratory failure in severe blunt chest trauma.
        J Trauma. 1982; 22: 221-226
        • Poole G.V.
        • Morgan D.B.
        • Cranston P.E.
        • et al.
        Computed tomography in the management of blunt thoracic trauma.
        J Trauma. 1993; 35: 296-300
        • Schild H.
        • Strunk H.
        • Stoerkel S.
        • et al.
        Computertomographie der Lungenkontusion.
        Fortschr Roentgenstr. 1986; 145: 519-526
        • Trupka A.
        • Waydhas C.
        • Hallfeldt K.K.
        • et al.
        Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study.
        J Trauma. 1997; 43: 405-411
        • Wagner R.B.
        • Jamieson P.M.
        Pulmonary contusion: evaluation and classification by computed tomography.
        Surg Clin N Am. 1989; 69: 31-40
        • Wilson D.
        • Voystock J.F.
        • Sariego J.
        • et al.
        Role of computed tomography scan in evaluating the widened mediastinum.
        Am Surg. 1994; 60: 421-423