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

Matthias TRAUB, Mark STEVENSON, Suzanne MCEVOY, Greg BRIGGS, Sing Kai LO, Steven LEIBMAN, Tony JOSEPH

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Abstract

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. Copyright © 2006 Elsevier Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)43-47
JournalInjury
Volume38
Issue number1
DOIs
Publication statusPublished - 2007

Fingerprint

Thorax
Tomography
X-Rays
Wounds and Injuries
Thoracic Wall
Air
Scapula
Information Management
Thoracic Injuries
Sternum
Vital Signs
Contusions
Trauma Centers
Ribs
Pneumothorax
varespladib methyl
Hematoma
Medical Records
Spine
Observation

Citation

Traub, M., Stevenson, M., McEvoy, S., Briggs, G., Lo, S. K., Leibman, S., & Joseph, T. (2007). The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury, 38(1), 43-47. doi: 10.1016/j.injury.2006.07.006

Keywords

  • Blunt chest trauma
  • Clinical predictors
  • CT chest scan
  • Chest X-ray