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The sensitivity of chest X-ray (CXR) for the detection of significant thoracic injury in children exposed to blast

Published:December 03, 2022DOI:https://doi.org/10.1016/j.injury.2022.12.001

      Highlights

      • Thoracic trauma is an important cause of morbidity and mortality in children exposed to blast and early recognition of these injuries is vital.
      • No studies have investigated the sensitivity of chest X-ray (CXR) for the detection of chest injury in paediatric blast casualties.
      • CXR findings were compared to the ‘gold standard’ of CT for detection of significant thoracic injuries in 103 children who were injured by blast.
      • CXR has low sensitivity for detecting thoracic injury in children exposed to blast, necessitating a low threshold for the use of CT for such patients.

      Abstract

      Introduction

      Thoracic trauma is an important cause of morbidity and mortality in children exposed to blast and early recognition of these injuries is vital. While numerous studies have investigated the sensitivity of chest X-ray (CXR) for the detection of chest injury in blunt trauma, none have evaluated its performance in paediatric blast injury.

      Methods

      CXR and Computed Tomography (CT) thorax findings were compared for 105 children who were injured by blast and presented to the UK Role 3 Hospital, Camp Bastion, Helmand Province, during the recent conflict in Afghanistan from 2011 to 2013. CXR performance was evaluated compared to the ‘gold standard’ of CT for the detection of significant thoracic injuries, defined as pneumothorax, haemothorax, aortic or great vessel injury, 2 or more rib fractures, ruptured diaphragm, sternal fracture, penetrating fragments and pulmonary contusion or laceration.

      Results

      The sensitivity of CXR for the detection of significant injuries was: pneumothorax 43%, haemothorax 40%, contusion 44%, laceration 100%, blast lung 80% and subdermal metallic fragments 75%. CXR missed all cases of diaphragm injury, ≥2 rib fractures, clavicle fracture and pleural effusion, although numbers of each were small. Specificity for CXR injury detection was 94% for contusion and 93% for fragment, and 100% otherwise. The sensitivity and specificity of CXR for identifying an abnormality that would prompt CT imaging was 72% (95% CI 55–85%) and 82% (95% CI 70–90%).

      Conclusions

      CXR has a poor sensitivity for the identification of significant thoracic injury in children exposed to blast. We argue that, given the challenge of clinical assessment of injured children and the potential for serious adverse consequences of missed thoracic injuries, there should be a low threshold for the use of CT chest in the evaluation of children exposed to blast.

      Keywords

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