title: Chest computed tomography for penetrating thoracic trauma after normal screening chest roentgenogram.
abstract: BACKGROUND
  Chest computed tomography (CCT) is a method of screening for intrathoracic injuries in hemodynamically stable patients with penetrating thoracic trauma. The objective of this study was to examine the changes in utilization of CCT over time and evaluate its contribution to guiding therapeutic intervention.
  
  
  METHODS
  A level 1 trauma center registry was queried between 2006 and 2011. Patients undergoing CCT in the emergency department after penetrating thoracic trauma as well as patients undergoing thoracic operations for penetrating thoracic trauma were identified. Patient demographics, operative indications, use of CCT, injuries, and hospital admissions were analyzed.
  
  
  RESULTS
  In all, 617 patients had CCTs performed, of whom 61.1% (371 of 617) had a normal screening plain chest radiograph (CXR). In 14.0% (51 of 371) of these cases, the CCT revealed findings not detected on screening CXR. The majority of these injuries were occult pneumothoraces or hemothoraces (84.3%; 43 of 51), of which 27 (62.8%) underwent tube thoracostomy. In only 0.5% (2 of 371), did the results of CCT alone lead to an operative indication: exploration for hemopericardium. The use of CCT in our patients significantly increased overall (28.8% to 71.4%) as well as after a normal screening CXR (23.3% to 74.6%) over the study period.
  
  
  CONCLUSIONS
  The use of CCT for penetrating thoracic trauma increased 3.5-fold during the study period with a concurrent increase in findings of uncertain clinical significance. Patients with a normal screening CXR should be triaged with 3-hour delayed CXR, serial physical examinations, and focused assessment with sonography for trauma; and CCT should only be used selectively as a diagnostic modality.
authors.affiliation: Department of Surgery, Division of General Surgery, University of Illinois at Mount Sinai Hospital, and Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60608, USA. nathan.mollberg@gmail.com
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Mollberg
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wise
authors.forename: Alberto L
authors.initials: AL
authors.lastname: De Hoyos
authors.forename: Fang-Ju
authors.initials: FJ
authors.lastname: Lin
authors.forename: Gary
authors.initials: G
authors.lastname: Merlotti
authors.forename: Malek G
authors.initials: MG
authors.lastname: Massad
mesh_terms: D000293:Adolescent; D000328:Adult; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008403:Mass Screening; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000601:surgery; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery; D011237:Predictive Value of Tests; D012042:Registries; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers; D014600:Utilization Review / Q000706:statistics & numerical data; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult