Routine Helical Computed Tomographic Evaluation of the Mediastinum in High-Risk Blunt Trauma Patients

Risk Factors for Traumatic Injury Findings on Thoracic Computed Tomography Among Patients With Blunt Trauma Having a Normal Chest Radiograph

“…However, the possibility of aortic injury (and the reported insensitivity of CRs for this potentially lethal injury) has led many physicians to err on the side of caution and obtain TCT if questions remain. 6 Establishing indications to pursue TCT after a normal CR could spare patients unnecessary radiation exposure while safely conserving health care resources. We sought to identify risk fac-tors that might predict acute traumatic injury findings on TCT among patients with blunt trauma having a normal initial screening CR.…”

Vascular Trauma: New Directions in Screening, Diagnosis and Management

“…Detection of these few patients has long been a subject of debate. Chest x-ray is the primary screening exam, however, it can be normal in up to 44% of patients with TAI, and positive findings are nonspecific (Demetriades, et al, 1998;Raptopoulos, et al, 1992;Woodring. 1990).…”

“…CT's done for this purpose will reveal injuries in 5-25% of patients with normal x-rays, but will lead to a change in management in ≤ 6% of cases (Barrios, et al, 2009;Kaiser, et al, 2011;Raptopoulos, et al, 1992). Although chest x-ray may miss up to 7-8% of TAI, use of CT as a screening tool indiscriminately is unlikely to be productive or cost effective and may result in unnecessary radiation exposure with attendant increase in cancer risk (Demetriades, et al, 1998;Kaiser, et al, 2011;Melton, et al, 2004). Careful screening with chest x-ray and directed imaging in the presence of traumatic findings or in very carefully selected victims of suspicious mechanisms in the presence of previously mentioned risk factors is likely to prevent overutilization of CT and avoid missed TAI.…”

Routine CT- Chest in Primary Evaluation of the Major Blunt Trauma Patients; Pros and Cons

“…Several authors reported the detection of clinically significant findings more frequently on CCT in 'high risk' blunt trauma admissions, These patients included but were not limited to high-speed motor vehicle collisions, >15 foot falls, pedestrian versus motor vehicle collisions, patients with any sign of thoracic trauma on physical examination or any mediastinal abnormalities on CxR (Demetriades et al, 1998;Exadaktylos et al, 2001). A significant number of these patients (14-65%) can have a completely normal CxR (Trupka et al, 1997;Demetriades et al, 1998;Exadaktylos et al, 2001;Plurad et al, 2007). The lethality of the occult injury defines the urgency and pertinence of subsequent clinical action.…”