title: Initial assessment of chest X-ray in thoracic trauma patients: Awareness of specific injuries.
abstract: OBJECTIVE
  To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist.
  
  
  METHODS
  By retrospective analysis of a prospective database, 712 patients with an injury to the chest admitted to the University Medical Center Utrecht were studied. All patients with a CXR were included in the study. Every CXR was re-evaluated by a trauma radiologist, who was blinded for the initial results. The findings of the trauma radiologist regarding rib fractures, pneumothoraces, hemothoraces and lung contusions were compared with the initial reports from the trauma team, derived from the original patient files.
  
  
  RESULTS
  A total of 516 patients with both thorax trauma and an initial CXR were included in the study. After re-evaluation of the initial CXR significantly more lung contusions (53.3% vs 34.1%, P < 0.001), hemothoraces (17.8% vs 11.0%, P < 0.001) and pneumothoraces (34.4% vs 26.4%, P < 0.001) were detected. During initial assessment significantly more rib fractures were reported (69.8% vs 62.3%, P < 0.001).
  
  
  CONCLUSIONS
  During the initial assessment of a CXR from trauma patients in the emergency department, a significant number of treatment-dictating injuries are missed. More awareness for these specific injuries is needed.
authors.affiliation: Tjeerd S Aukema, Falco Hietbrink, Luke PH Leenen, Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Tjeerd S
authors.initials: TS
authors.lastname: Aukema
authors.forename: Ludo Fm
authors.initials: LF
authors.lastname: Beenen
authors.forename: Falco
authors.initials: F
authors.lastname: Hietbrink
authors.forename: Luke Ph
authors.initials: LP
authors.lastname: Leenen