title: Criteria for the selective use of chest computed tomography in blunt trauma patients.
abstract: OBJECTIVE
  The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury.
  
  
  METHODS
  This observational study prospectively included consecutive patients (>or=16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre.
  
  
  RESULTS
  We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age >or=55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with >or=1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant.
  
  
  CONCLUSIONS
  Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected.
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. M.brink@rad.umcn.nl
authors.forename: Monique
authors.initials: M
authors.lastname: Brink
authors.forename: Jaap
authors.initials: J
authors.lastname: Deunk
authors.forename: Helena M
authors.initials: HM
authors.lastname: Dekker
authors.forename: Michael J R
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Digna R
authors.initials: DR
authors.lastname: Kool
authors.forename: Arie B
authors.initials: AB
authors.lastname: van Vugt
authors.forename: Cornelis
authors.initials: C
authors.lastname: van Kuijk
authors.forename: Johan G
authors.initials: JG
authors.lastname: Blickman
mesh_terms: D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology