title: Standard computed tomography of the chest, abdomen, and pelvis is sensitive and cost-effective for the detection of fractures of the shoulder girdle.
abstract: Computed tomography of the chest, abdomen, and pelvis (CTCAP) has become the mainstay of diagnosis in stable blunt trauma patients. The purpose of this study was to investigate whether standard CTCAP has adequate sensitivity to identify fractures of the scapula, clavicle, and humeral  head to replace routine radiographs of the shoulder. A retrospective chart review was carried out from January 1, 2004, to December 31, 2007, at Morristown Memorial Hospital. Inclusion criteria were all shoulder fracture patients in our trauma registry who underwent both a CTCAP and plain  radiographs of the injured shoulder. Data were collected for patient age, sex, Injury Severity Score, mechanism of injury, and fracture location. Sensitivity was calculated for each diagnostic modality as well as hospital costs and radiation dose of plain radiographs. A total of 374 charts  were reviewed and 98 patients were included in the study with a total of 117 fractures. The sensitivity of trauma CTCAP for scapula fractures was 100 per cent, clavicle fractures 98 per cent, and humeral head fractures 100 per cent. The sensitivity of the shoulder series for scapula fractures  was 60 per cent, clavicle fractures 85 per cent, and humeral head fractures 100 per cent. The plain radiographs added $298 in hospital charges and 0.191 mSv of radiation per patient. CTCAP is a sensitive tool for identifying fractures in the shoulder girdle. Therefore, CTCAP can replace  the routine radiographs of the shoulder resulting in less total radiation exposure of the trauma patients. This also would lead to lower healthcare cost and better diagnostic workflow.
authors.affiliation: Department of Surgery, Morristown Medical Center, Morristown, New Jersey, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Adams
authors.forename: Jaroslaw W
authors.initials: JW
authors.lastname: Bilaniuk
authors.forename: Louis T
authors.initials: LT
authors.lastname: Difazio
authors.forename: Brian K
authors.initials: BK
authors.lastname: Siegel
authors.forename: Renay
authors.initials: R
authors.lastname: Durling-Grover
authors.forename: Denise
authors.initials: D
authors.lastname: McCarthy
authors.forename: Patricio
authors.initials: P
authors.lastname: Grob
authors.forename: Mark D
authors.initials: MD
authors.lastname: Bobbin
authors.forename: Robert S
authors.initials: RS
authors.lastname: Skerker
authors.forename: Zoltán H
authors.initials: ZH
authors.lastname: Németh
mesh_terms: D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D010388:Pelvis / Q000000981:diagnostic imaging; D011860:Radiography, Abdominal / Q000191:economics / Q000379:methods*; D013902:Radiography, Thoracic / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012784:Shoulder Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000191:economics*; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*