Complementary exams in blunt torso trauma. Perform only radiographs and fast: is it safe?

Abstract

Objective:to evaluate effectiveness of using chest X-ray (CXR), pelvis X-ray (RXP) and FAST (Focused Abdominal Sonography on Trauma) to exclude significant lesions of the body in blunt trauma.Methods:a prospective study involving 74 patients whom made the three tests (CXR, RXP and FAST) during the initial evaluation between October 2013 and February 2014. The results were compared to the tomography of the same patients or clinical outcome. If the patient did not have alterations on the CT scans or during the observation time, the initial workup was considered safe. All patients were evaluated at the Hospital João XXIII, Belo Horizonte, Brazil.Results:of the 74 patients studied the average age was 33 years, RTS: 6.98, ECG: 12. From 44 (59.45%) patients with exams (radiographs and FAST) unchanged, three had significant injuries (two splenic injuries and one liver injury) diagnosed by clinical monitoring. The remaining patients - 30 (40.55%) - had at least one alteration in conventional tests. Of these group 27 (90%) had significant injuries and three (10%) minor injuries. The sensitivity of all three tests for screening considerable lesions was 90% and the specificity was 93%. The negative predictive value was 93% and the positive predictive value 89%.Conclusion:this research showed that all the three exams - chest X-ray, pelvis and FAST - are safe to lead with the blunt trauma if well used and associated with clinical examination.

Pediatric trauma primary survey performance among surgical and non-surgical pediatric providers in a Brazilian trauma center

“…The use of screening CT is actively debated in trauma care, with some proposing its use in the initial evaluation, while others suggest selective CT scanning based on other findings. 21 A selective approach may be more feasible in countries with fewer resources, since CT scanning in such places can be very expensive or unavailable and the older scanners available deliver higher doses of radiation. 11 22 More research is needed to determine if this association is due to improved assessment alone or also due to increased severity among these patients as we were not powered to adjust for confounders among our secondary outcomes.…”