What is the role of chest X-ray in the initial assessment of stable trauma patients?
BACKGROUND
The Advanced Trauma Life Support course advocates the liberal use of chest X-ray (CXR) during the initial evaluation of trauma patients. We reviewed CXR performed in the trauma resuscitation room (TR) to determine its usefulness.


METHODS
A retrospective, registry-based review was conducted and included 1,000 consecutive trauma patients who underwent CXR in the TR at a Level I trauma center during a 7-month period.


RESULTS
Patients receiving CXR comprised 91.5% of all patients evaluated in the TR during the study period. CXR followed by chest computed tomography (CCT) was performed in 820 (82.0%) patients. Subsequent CCT identified missed findings in 235 (35.6%) of the 660 patients with an initial negative CXR who went on to receive CCT. CXR alone was performed in 127 (26.1%) of the 487 patients who were stable, not intubated, and had a normal chest physical examination (CPE). Seven patients (5.5%) in this group had potentially significant findings but none required intervention beyond physiotherapy or antibiotics. Three hundred and sixty (73.9%) of the 487 patients who were hemodynamically stable with a normal CPE underwent both CXR and CCT. Fifty-four patients (15%) in this group had findings of significance, and two (0.6%) required intervention. One patient received bilateral chest tubes for large pre-existing pleural effusions found on CXR and CCT; another patient undergoing general anesthesia required a chest tube for a pneumothorax found only on CCT.


CONCLUSIONS
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.
Wisbach
Gordon G
GG
Division of Trauma, Scripps Mercy Hospital, San Diego, California 92103, USA.
Sise
Michael J
MJ
Sack
Daniel I
DI
Swanson
Sophia M
SM
Sundquist
Sanna M
SM
Paci
Gabrielle M
GM
Kingdon
Kenneth M
KM
Kaminski
Stephen S
SS
D000328:Adult; D002140:California; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D013902:Radiography, Thoracic / Q000191:economics; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000191:economics