title: What is the role of chest X-ray in the initial assessment of stable trauma patients?
abstract: 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.
authors.affiliation: Division of Trauma, Scripps Mercy Hospital, San Diego, California 92103, USA.
authors.forename: Gordon G
authors.initials: GG
authors.lastname: Wisbach
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sise
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sack
authors.forename: Sophia M
authors.initials: SM
authors.lastname: Swanson
authors.forename: Sanna M
authors.initials: SM
authors.lastname: Sundquist
authors.forename: Gabrielle M
authors.initials: GM
authors.lastname: Paci
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kingdon
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Kaminski
mesh_terms: 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