Utility of Chest Radiography in Blunt Trauma
In the American Journal of Emergency Medicine this month, comes this interesting study from Iran, examining the role of performing routine chest x-rays as part of the initial evaluation in the stable blunt trauma patient.
Over a four month period, they prospectively looked at all the haemodynamically stable blunt trauma patients with normal physical exam. Chest x-rays were done, and then reviewed for abnormalities. They had a total of 1008 patients that were included, and found that only 1 patient (0.1%) had an abnormal chest x-ray (with the abnormality unrelated to trauma).
BACKGROUND:
Radiology plays an important role in evaluation of a trauma patient. Although chestradiography is recommended for initial evaluation of the trauma patient by the Advanced Trauma Life Support course, we hypothesized that precise physical examinations and history taking accurately identify those blunt trauma patients at low risk for chest injury, making routine radiographs unnecessary. Thus, this study was performed to investigate the role of chest radiography in initialevaluation of those trauma patients with normal physical examination.
METHODS:
In this prospective cross-sectional study, all the haemodynamically stable blunt trauma patients with negative physical examination result referred to our trauma center during a 4 month period (March-June 2009) were included. Chest radiographies were performed and reviewed for abnormalities.
RESULTS:
During the study period, 5091 blunt trauma patients referred to our center, out of which, 1008 were hemodynamically stable and had negative physical examination result. Only 1 (0.1%) patient had abnormal chest radiography that showed perihilar lymphadenopathy, unrelated to trauma.
CONCLUSION:
Performing routine chest radiography in stable blunt trauma patients is of low clinical value. Thus, decision making for performing chest radiography in blunt trauma patients based on clinical findings would be efficacious and resource saving.
This study challenges the routine dogma of ATLS, which recommends chest radiography in the initial evaluation of trauma patients. Is it time to change our practise, and individualise our care and tailor it to the patient in front of us?
Thoracic trauma, blunt trauma | in Radiology, Trauma Posted on Tuesday, January 10, 2012 at 4:19AM Email Article
Reader Comments (1)
Hi Amit
Coincidentally read this post as I was putting up my latest at Broome Docs. Is the CXR dead in trauma - between bedside US and CT - there is not much it adds?
Thoughts?
Casey