title: Role of the trauma-room chest x-ray film in assessing the patient with severe blunt traumatic injury.
abstract: OBJECTIVE
  To examine the accuracy of standard trauma-room chest x-ray films in assessing blunt abdominal trauma and to determine the significance of missed injuries under these circumstances.
  
  
  METHODS
  A retrospective review.
  
  
  METHODS
  A regional trauma unit in a tertiary-care institution.
  
  
  METHODS
  Multiply injured trauma patients admitted between January 1988 and December 1990 who died within 24 hours of injury and in whom an autopsy was done.
  
  
  METHODS
  Standard radiography of the chest.
  
  
  METHODS
  Chest injuries diagnosed and recorded by the trauma room team from standard anteroposterior x-ray films compared with the findings at autopsy and with review of the films by a staff radiologist initially having no knowledge of the injuries and later, if injuries remained undetected, having knowledge of the autopsy findings.
  
  
  RESULTS
  Thirty-seven patients met the study criteria, and their cases were reviewed. In 11 cases, significant injuries were noted at autopsy and not by the trauma-room team, and in 7 cases these injuries were also missed by the reviewing radiologist. Injuries missed by the team were: multiple rib fractures (11 cases), sternal fractures (3 cases), diaphragmatic tear (2 cases) and intimal aortic tear (1 case). In five cases, chest tubes were not inserted despite the presence (undiagnosed) of multiple rib fractures and need for intubation and positive-pressure ventilation.
  
  
  CONCLUSIONS
  Significant blunt abdominal trauma, potentially requiring operative management or chest-tube insertion, may be missed on the initial anteroposterior chest x-ray film. Caution must therefore be exercised in interpreting these films in the trauma resuscitation room.
authors.affiliation: Trauma Unit, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont.
authors.forename: B A
authors.initials: BA
authors.lastname: McLellan
authors.forename: J
authors.initials: J
authors.lastname: Ali
authors.forename: M J
authors.initials: MJ
authors.lastname: Towers
authors.forename: W
authors.initials: W
authors.lastname: Sharkey
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D006801:Humans; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*