Clinical decision rule to prevent unnecessary chest <scp>X</scp>‐ray in patients with blunt multiple traumas

Forouzanfar, Mohammad Mehdi; Safari, Saeed; Niazazari, Maryam; Baratloo, Alireza; Hashemi, Behrooz; Hatamabadi, Hamid Reza; Rahmati, Farhad; Taheri, Morteza Sanei

doi:10.1111/1742-6723.12302

Cited by 19 publications

(14 citation statements)

References 19 publications

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“…The present survey was the first to evaluate the validity of the TIRC model in a multi-center setting, while its derivation study was conducted on 2600 subjects referring to a single center. 10 Therefore, generalization of the model was considered as one of the limitations in their study 10 till the present survey found a similar validity for the model through a multi-center approach. In comparison, both the NEXUS chest and the TIRC model have acceptable sensitivities in detection of thoracic traumatic injuries.…”

Section: Discussionmentioning

confidence: 54%

“…The discriminatory power was evaluated through calculating area under the curve of the receiver operating characteristic curve (ROC) and presenting the result as sensitivity, specificity and likelihood ratios. Based on TIRC cut off (presence of at least one criteria), 10 data were presented as true positive (true prediction of presence of thoracic injury in CXR), true negative (true prediction of absence of thoracic injury in CXR), false positive (false prediction of presence of thoracic injury in CXR), and false negative (false prediction of absence of thoracic injury in CXR).…”

Section: Discussionmentioning

confidence: 99%

“…Exclusion criteria included being the subject of penetrating traumas and not willing to participate. These criteria were based on the study carried out by Forouzanfar et al 10 …”

Section: Participantsmentioning

confidence: 99%

“…According to this model any of these factors can predict a thoracic lesion: age over 60, hemodynamic instability, Glasgow Coma Scale (GCS) lower than 15, crepitation, decrease in pulmonary sounds, pain and tenderness of the chest wall, thoracic skin abrasion, and dyspnea. 10 As can be seen, this model does not have the limitations of NEXUS chest scoring system. However, the validity of the TIRC model has not been evaluated in another survey.…”

Section: Introductionmentioning

confidence: 96%

“…In this regard two different scoring systems of NEXUS chest and thoracic injury rule out criteria (TIRC) have been proposed by two separate research teams. 10,11 NEXUS chest, developed based on the data from 2628 patients referring to three trauma centers, is a 7-item scoring system that includes age of more than 60 years old, rapid deceleration mechanism (falling from a height of more than 20 ft or a motor vehicle accident with a speed of more than 40 mph), chest pain, intoxication, altered mental status, distracting painful injury and tenderness to chest wall palpitation as factors predictive of thoracic trauma. The validation study of this scoring system was conducted on 9905 patients.…”

Section: Introductionmentioning

confidence: 99%

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Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma

Safari

Yousefifard

Baikpour

et al. 2016

Journal of Clinical Orthopaedics and Trauma

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a b s t r a c tBackground: Thoracic injury rule out criteria (TIRC) were first introduced as a decision instrument for selective chest radiography in blunt thoracic trauma in 2014. However, the validity of this model has not been assessed in other studies. In this regard, the present survey evaluates the validity of TIRC model in a multi-center setting.Methods: In this cross-sectional study, clinical presentations and chest radiograms of multiple trauma patients referring to 6 educational hospitals in Iran were evaluated. Data were gathered prospectively during 2015. In each center, data collection and interpretation of radiograms were conducted by two different emergency medicine specialists. Measures were then taken for assessment of discriminatory power and calibration of the model. Results:Data from 2905 patients were gathered (73.17% were male; the mean age was 33.53 AE 15.42 years). Area under the receiver operating characteristics curve of the TIRC model for detection of thoracic traumatic injuries was 0.93 (95%CI: 0.93-0.94). Sensitivity andspecificity of the model were 100 (98.91-100) and 67.65 (65.76-69.45), respectively.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

“…Exclusion criteria included being the subject of penetrating traumas and not willing to participate. These criteria were based on the study carried out by Forouzanfar et al 10 …”

Section: Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma

Safari

Yousefifard

Baikpour

et al. 2016

Journal of Clinical Orthopaedics and Trauma

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View full text Add to dashboard Cite

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Clinical predictors of abnormal chest CT scan findings following blunt chest trauma: A cross-sectional study

Safari

Farbod

Hatamabadi

et al. 2020

Chinese Journal of Traumatology

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Comparison of intercostal nerve blockage versus local anesthesia for tube thoracostomy insertion; a randomised controlled trial

Mousavi

Davoodabadi

Izadian

et al. 2022

International Journal of Surgery Open

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Background Tube thoracostomy (TT) insertion is common and painful. Since thoracic pain concludes to lung atelectasis and following disadvantages, therefore pain control is fundamental. There is no general consensus on any analgesic method in this regard. This study aims to compare intercostal nerve blockage (ICNB) and local anesthesia (LA) considering postoperative effects. Method This is a randomized controlled double-blinded survey. Eligible conscious subjects were selected randomly from non-traumatic patients who were admitted in hospital but not candidate for further surgery. The only surgical intervention was a classic TT insertion. Preoperative anesthesia was conducted through ICNB or LA approach with total 15 mL bupivacaine 0.5% for every patient. Severity of pain was demonstrated using visual analogue scale method for five times. Also total administered opioid was registered. Results Data was adopted from 64 eligible patients. There was no difference between demographic variables(P > 0.05). Pain significantly mitigated following ICNB during TT insertion and also last for at least 6 h after surgery(p < 0.001). Additionally, cumulative dose of prescribed pethidine after ICNB was obviously lower than when LA approach was conducted(p < 0.001). There was no remarkable postoperative side effect among participants. Conclusion Preoperative ICNB anesthesia for TT insertion is advised because of its capability to reduce whether postoperative pain or need for opioid injection that both potentially are associated with respiratory depression. Highlights

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Clinical decision rule to prevent unnecessary chest X‐ray in patients with blunt multiple traumas

Abstract: Based on TIRC, it seems that CXR in stable multiple blunt trauma patients who are conscious and under 60 and have no decrease in pulmonary sounds, no dyspnea, no thoracic skin abrasion, and no crepitation can be ignored.

Cited by 19 publications

References 19 publications

Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma

Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma

Clinical predictors of abnormal chest CT scan findings following blunt chest trauma: A cross-sectional study

Comparison of intercostal nerve blockage versus local anesthesia for tube thoracostomy insertion; a randomised controlled trial

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