What is the Role of Chest X-Ray in the Initial Assessment of Stable Trauma Patients?

Abstract

In stable trauma patients with a normal CPE, CXR appears to be unnecessary in their initial evaluation. CXR should be relegated to a role similar to cervical spine and pelvis radiographs in the initial evaluation of hemodynamically stable trauma patients with a normal physical examination, and should be limited to use only for clear clinical indications.

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

“…This study declared that chest radiography should only be performed, if an evident clinical indication is present, similar to the way that cervical and pelvic radiographies are approached. 12 On the other hand, …”

“…Sample size calculation was based on a 6.5% prevalence of thoracic lesions in multiple trauma patients 12 considering a confidence interval of 95% (a = 0.05), a power of 90% (b = 0.1), and a maximum error of 1.5% (d = 0.015). The minimum number of patients required as the sample population was estimated to be 1038 subjects.…”

The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study

“…13 Accurately diagnosing patients with BTAI is imperative to the survival of the patient. It is well documented that chest X-ray is inferior as a diagnostic tool, 14 and the most recent iteration of the Eastern Association for the Surgery of Trauma guidelines advocate ''Computed tomography of the chest with intravenous contrast . to diagnose clinically significant BTAI.''…”

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

“…For example, the finding of an aortic or great vessel injury or spine fracture would mandate critical management or diagnostic manoeuvres, while the diagnosis of an occult pneumothorax may not (Brazel et al, 1999). Therefore, use of CCT in Selected patients can lead to significant changes in patient management (18-41%) (Trupka et al, 1997;Guerrero-Lopez et al, 2000;Renton, 2003;Salim et al, 2006;Deunk et al, 2007) while application of CCT more liberally results in little consequential intervention overall (Blostein and Hodgeman, 1997;Plurad et al, 2007;Wisbach et al, 2007) based on these occult diagnoses. On the other hand, others argue that the highe r d i s c o v e r y o f i n j u r i e s w i t h C T i s o f questionable clinical significance at great costs.…”