title: The use of chest computed tomography versus chest X-ray in patients with major blunt trauma.
abstract: BACKGROUND
  Computed tomography (CT) scans are often used in the evaluation of patients with blunt trauma. This study identifies the clinical features associated with further diagnostic information obtained on a CT chest scan compared with a standard chest X-ray in patients sustaining blunt trauma to the chest.
  
  
  METHODS
  A 2-year retrospective survey of 141 patients who attended a Level 1 trauma centre for blunt trauma and had a chest CT scan and a chest X-ray as part of an initial assessment was undertaken. Data extracted from the medical record included vital signs, laboratory findings, interventions and the type and severity of injury.
  
  
  RESULTS
  The CT chest scan is significantly more likely to provide further diagnostic information for the management of blunt trauma compared to a chest X-ray in patients with chest wall tenderness (OR=6.73, 95% CI=2.56, 17.70, p<0.001), reduced air-entry (OR=4.48, 95% CI=1.33, 15.02, p=0.015) and/or abnormal respiratory effort (OR=4.05, 95% CI=1.28, 12.66, p=0.017). CT scan was significantly more effective than routine chest X-ray in detecting lung contusions, pneumothoraces, mediastinal haematomas, as well as fractured ribs, scapulas, sternums and vertebrae.
  
  
  CONCLUSIONS
  In alert patients without evidence of chest wall tenderness, reduced air-entry or abnormal respiratory effort, selective use of CT chest scanning as a screening tool could be adopted. This is supported by the fact that most chest injuries can be treated with simple observation. Intubated patients, in most instances, should receive a routine CT chest scan in their first assessment.
authors.affiliation: Trauma Service, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia.
authors.forename: Matthias
authors.initials: M
authors.lastname: Traub
authors.forename: Mark
authors.initials: M
authors.lastname: Stevenson
authors.forename: Suzanne
authors.initials: S
authors.lastname: McEvoy
authors.forename: Greg
authors.initials: G
authors.lastname: Briggs
authors.forename: Sing Kai
authors.initials: SK
authors.lastname: Lo
authors.forename: Steven
authors.initials: S
authors.lastname: Leibman
authors.forename: Tony
authors.initials: T
authors.lastname: Joseph
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003288:Contusions / Q000000981:diagnostic imaging; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006491:Hemothorax / Q000000981:diagnostic imaging; D006801:Humans; D015601:Injury Severity Score; D055370:Lung Injury; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*