Chest X-rays in detecting injuries caused by blunt trauma

doi:10.5847/wjem.j.1920-8642.2016.01.010

Abstract

Abstract:

BACKGROUND: The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarified at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma.
METHODS: A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009-2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists.
RESULTS: Of the 447 patients, 309 (69.1%) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3%) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in detecting clavicle fractures [95%CI 78.3 (63.6-89)] but the lowest in pneuomediastinum [95%CI 11.8 (1.5-36.4)]. The specificity of CXR was close to 100% in detecting a wide array of entities.
CONCLUSION: CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma. Moreover, stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

Key words: Chest, Blunt trauma, X-Rays, Computed tomography, Emergency department

Kadir Agladioglu, Mustafa Serinken, Onur Dal, Halil Beydilli, Cenker Eken, Ozgur Karcioglu. Chest X-rays in detecting injuries caused by blunt trauma[J]. World Journal of Emergency Medicine, 2016, 7(1): 55-58.

Figures/Tables 3

Figure 1.

Table 1

Table 2

References 14

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Variables	n (%)
Gender
Male	309 (69.1)
Female	138 (30.9)
Mechanism of injury
MVA-passenger	158 (35.3)
MVA-pedestrian	92 (20.6)
Fall from heights	76 (17.0)
Bicycle, motorcycle and sport-related injury	30 (6.7)
Others	91 (20.4)
Dyspnea
No	358 (80.1)
Yes	89 (19.9)
Pain on palpation
No	222 (49.7)
Yes	225 (50.3)
Subcutaneous crackles
No	351 (78.5)
Yes	96 (21.5)
Chest abrasions
No	247 (55.3)
Yes	200 (44.7)
Disposition
Admission	317 (70.9)
Discharge	81 (18.1)
Transfer to another institution	45 (10.1)
Death	4 (0.9)

Diagnostic validity of CXR	Sensitivity (95%CI)	Specificity (95%CI)	Positive likelihood ratio (95%CI)	Negative likelihood ratio (95%CI)
Pneumothorax	33 (25-42)	100 (98.9-100)	Cannot be calculated	0.67 (0.59-0.76)
Hemothorax	27 (16.6-39.7)	100 (99-100)		0.73 (0.63-0.85)
Contusion	31.7 (21.9-42.9)	100 (99-100)	Cannot be calculated	0.68 (0.59-0.79)
Rib fracture	55.3 (47-63.5)	100 (98.8-100)	Cannot be calculated	0.45 (0.37-0.53)
Clavicular fracture	78.3 (63.6-89)	99.8 (98.6-100)	313.8 (44-2 236)	0.22 (0.13-0.38)
Scapular fracture	0 (0-33.6)	100 (99.2-100)	Cannot be calculated	1 (1-1)
Pneuomediastinum	11.8 (1.5-36.4)	100 (99.2-100)	Cannot be calculated	0.88 (0.74-1.05)

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