title: Provider perceptions concerning use of chest x-ray studies in adult blunt trauma assessments.
abstract: BACKGROUND
  Although they infrequently lead to management changing diagnoses, chest x-rays (CXRs) are the most commonly ordered imaging study in blunt trauma evaluation.
  
  
  OBJECTIVE
  To determine: 1) the reasons physicians order chest X-ray studies (CXRs) in blunt trauma assessments; 2) what injuries they expect CXRs to reveal; and 3) whether physicians can accurately predict low likelihood of injury on CXR.
  
  
  METHODS
  At a Level I Trauma Center, we asked resident and attending physicians treating adult blunt trauma patients: 1) the primary reason(s) for getting CXRs; 2) what, if any, significant intrathoracic injuries (SITI) they expected CXRs to reveal; and 3) the likelihood of these injuries. An expert panel defined SITI as two or more rib fractures, sternal fracture, pulmonary contusion, pneumothorax, hemothorax, or aortic injury on official CXR readings.
  
  
  RESULTS
  There were 484 patient encounters analyzed--65% of participating physicians were residents and 35% were attendings; 16 (3.3%) patients had SITI. The most common reasons for ordering CXRs were: "enough concern for significant injury" (62.9%) and belief that CXR is a "standard part of trauma work-up" (24.8%). Residents were more likely than attendings to cite "standard trauma work-up" (mean difference = 13.5%, p = 0.003). When physicians estimated a < 10% likelihood of SITI on CXR, 2.1% (95% confidence interval [CI] 1.0-4.1%) of patients had SITI; when they predicted a 10-25% likelihood, 5.7% (95% CI 1.2-15.7%) had SITI; and when they predicted a > 25% likelihood, 9.1% (95% CI 3.0-20.0%) had SITI.
  
  
  CONCLUSIONS
  Physicians order CXRs in blunt trauma patients because they expect to find injuries and believe that CXRs are part of a "standard" work-up. Providers commonly do not expect CXRs to reveal SITI. When providers estimated low likelihood of SITI, the rate of SITI was very low.
authors: Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, California 94110, USA.
authors: Georgina
authors: G
authors: Calderon
authors: Daniel
authors: D
authors: Perez
authors: Jonathan
authors: J
authors: Fortman
authors: Bory
authors: B
authors: Kea
authors: Robert M
authors: RM
authors: Rodriguez
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D004522:Educational Status; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging; D010818:Practice Patterns, Physicians'; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012253:Rib Fractures / Q000000981:diagnostic imaging; D018570:Risk Assessment; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014193:Trauma Centers; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*