title: Ability of a chest X-ray and an abdominal computed tomography scan to identify traumatic thoracic injury.
abstract: OBJECTIVE
  Our objective was to show that a chest X-ray (CXR) and an abdominal computed tomography (CT) scan are sufficient to identify most clinically significant thoracic injuries in trauma patients, rendering the thoracic CT scan useful in only a subset of patients.
  
  
  METHODS
  A retrospective study identified thoracic injuries in 374 trauma patients evaluated with a CXR, a thoracic CT scan, and an abdominal CT scan. Injuries seen on the initial CXR versus those seen on a CT scan only (occult) were identified and assessed for clinical relevance.
  
  
  RESULTS
  An abdominal CT scan identified 65% (15/23) of occult pneumothoraces, 100% (25/25) of occult hemothoraces, 64% (18/28) of occult pulmonary contusions, and 58% (18/31) of occult rib fractures. No occult pneumothoraces seen on the thoracic CT scan alone required tube thoracostomy.
  
  
  CONCLUSIONS
  Our pilot study suggests that a CXR and an abdominal CT scan will identify most occult intrathoracic injuries. Reserving a thoracic CT scan for patients with an abnormal CXR or high-risk mechanism could safely reduce cost and radiation exposure while still diagnosing significant thoracic injuries.
authors.affiliation: Division of Trauma, Critical Care, Burn and Acute Care Surgery, Department of Surgery, University of California Irvine Medical Center, CA, USA. cbarrios@uci.edu
authors.forename: Cristobal
authors.initials: C
authors.lastname: Barrios
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pham
authors.forename: Darren
authors.initials: D
authors.lastname: Malinoski
authors.forename: Matthew
authors.initials: M
authors.lastname: Dolich
authors.forename: Michael
authors.initials: M
authors.lastname: Lekawa
authors.forename: Marianne
authors.initials: M
authors.lastname: Cinat
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries; D003288:Contusions / Q000000981:diagnostic imaging; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging; D006801:Humans; D055370:Lung Injury / Q000000981:diagnostic imaging; D008297:Male; D009104:Multiple Trauma; D010490:Pericardial Effusion / Q000000981:diagnostic imaging; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D012253:Rib Fractures / Q000000981:diagnostic imaging; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*