[Significance of findings of chest X-rays and thoracic CT routinely performed at the emergency unit: 102 patients with multiple trauma. A prospective study].
OBJECTIVE
To evaluate prospectively whether and to what extent both thoracic computed tomography (Tx-CT) and supine X-ray of the chest (Rx-Tx) are able to show additional findings that are therapeutically relevant.


METHODS
According to a fixed study protocol, we performed Rx-Tx and Tx-CT in 102 consecutive, haemodynamically stable polytrauma patients (mean age, 41.2 yrs; age range, 12-93 yrs). Findings of therapeutical relevance drawn from both Tx-CT and Rx-Tx, and urgent interventions indicated by an attending trauma team were documented on a standardized evaluation sheet immediately. Any change in the patient's management that is different from routine life-saving procedures, and any therapeutical intervention done in the emergency room or elsewhere (operating theatre, angiographic facility) were considered therapeutically relevant.


RESULTS
Of 102 patients, 43 (42.2%) had a total of 51 therapeutically relevant findings. Rx-Tx alone yielded 23 relevant findings (45.1%) in 23 patients (22.5%). Of them, Tx-CT has shown additional important findings in 7 patients (30.4%). When Tx-CT alone is considered, it revealed 22 new findings of therapeutical relevance (43.2%) in 20 patients (46.5%). Altogether, Tx-CT was able to show 30 relevant findings in 27 patients, i.e., there was a therapeutical benefit for 26.5% of all polytrauma patients included. Most frequently, there was a need for chest-tube insertion (n = 29).


CONCLUSIONS
Polytrauma patients if haemodynamically stable may profit from computed tomography of the chest when therapeutically relevant thoracic injuries are looked for or early therapeutical interventions are to be checked. However, chest X-ray should stay as a "front-line" screening method because of its superbly quick feasibility and availability.
Klinik für Diagnostische Radiologie und Neuroradiologie Zentralklinikum Augsburg. radiol.klin.augsburg@gmx.de
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T
Grieser
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Bühne
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Häuser
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Bohndorf
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003937:Diagnosis, Differential; D005069:Evaluation Studies as Topic; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D011030:Pneumothorax / Q000000981:diagnostic imaging; D011446:Prospective Studies; D013902:Radiography, Thoracic; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed