Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma.
OBJECTIVE
To determine the utility of thoracic computed tomography (TCT) in the initial assessment of critically ill patients with chest injuries.


METHODS
Prospective observational study of cohorts.


METHODS
Trauma intensive care unit (ICU) of a Spanish Level III hospital (US equivalent Level I).


METHODS
Three hundred seventy-five patients with chest injuries were studied, grouped into two cohorts according to whether they underwent admission TCT (exposed cohort, group I, n = 104) or not (unexposed cohort, group II, n = 271).


METHODS
None.


RESULTS
Demographic data, initial severity scores, and chest radiograph (CXR)-based diagnosis were collected in all patients as independent variables. In patients of group I, we also recorded the TCT-based diagnosis and any incidents, complications, or therapy changes resulting from the TCT. The need for and duration of mechanical ventilation, length of ICU stay, and ICU mortality were gathered in the whole sample as dependent variables. The admission data were similar in the two groups, except for a higher Injury Severity Score (ISS) and thoracic ISS in group I. TCT proved to be more sensitive than CXR in detecting pulmonary contusion, hemothorax, pneumothorax, and vertebral fractures and in identifying the faulty placement of chest drainage tubes. TCT findings induced therapy changes in approximately 30% of patients in group I. In the other dependent variables studied, there were no differences between the two groups. In the multivariate analysis, the TCT screening had no effects on the time on mechanical ventilation, length of ICU stay, or mortality.


CONCLUSIONS
TCT detects more chest injuries in trauma patients than does CXR and induces therapy changes in a considerable number of patients. However, this does not translate into an improvement in clinical outcomes.
Guerrero-López
F
F
Department of Emergency and Critical Care Medicine, Virgen de las Nieves University Hospital, Granada, Spain.
Vázquez-Mata
G
G
Alcázar-Romero
P P
PP
Fernández-Mondéjar
E
E
Aguayo-Hoyos
E
E
Linde-Valverde
C M
CM
D018806:APACHE; D000328:Adult; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000401:mortality; D010343:Patient Admission / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000401:mortality; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality