title: Prospective evaluation of early follow-up chest radiography after penetrating thoracic injury.
abstract: BACKGROUND
  In asymptomatic patients with penetrating thoracic trauma and a normal initial chest x-ray, successive prospective trials have decreased the minimum observation period required for exclusion of significant injury from 6 to 3 h. Despite the quality of these studies, this interval remains arbitrary and the true requisite observation time for safe discharge remains unknown. The current study evaluates the ability of "early" repeat chest x-ray, at intervals approaching 1 h, to exclude clinically significant injury.
  
  
  METHODS
  Eighty-eight, asymptomatic patients with penetrating chest trauma and normal initial chest radiographs were prospectively enrolled in this study. All patients received an "early" follow-up chest x-ray, at a median interval of 1 h and 34 min (interquartile range: 1 h 35 min to 2 h 22 min), and a second repeat x-ray at a "delayed" interval no earlier than 3 h postadmission. Radiographic abnormalities in clinically stable patients were followed with serial examination and repeat imaging for a minimum of 6 h. All patients received both "early" and "delayed" repeat CXRs with no patient discharged before full assessment.
  
  
  RESULTS
  One of the 88 patients with initially normal chest x-ray underwent tube thoracostomy at the discretion of the attending surgeon before any repeat imaging. Of the remaining patients, 4 of 87 (4.6 %) demonstrated radiographic abnormalities on "early" repeat imaging. Two patients had pneumothoraces, successfully managed without intervention; the remaining two demonstrated evidence of hemothorax, subsequently undergoing tube thoracostomy. Two more patients (2.3 %) developed pneumothoraces on "delayed" imaging, both successfully observed without intervention.
  
  
  CONCLUSIONS
  In asymptomatic patients with penetrating thoracic trauma and normal initial chest radiographs, "early" repeat chest x-ray, at intervals approaching 1 h, appears sufficient to exclude clinically significant pathology and to allow safe patient discharge.
authors.affiliation: Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, 1200 North State Street, Los Angeles, CA 90033, USA.
authors.forename: Regan J
authors.initials: RJ
authors.lastname: Berg
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Gustavo
authors.initials: G
authors.lastname: Recinos
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Chrysanthos
authors.initials: C
authors.lastname: Georgiou
authors.forename: David
authors.initials: D
authors.lastname: Shatz
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D015505:Chest Tubes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013902:Radiography, Thoracic; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D013907:Thoracostomy; D013997:Time Factors; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery
references.citation: Acad Emerg Med. 2001 Feb;8(2):151-5
references.pmid: 11157291
references.citation: AJR Am J Roentgenol. 1986 May;146(5):1049-50
references.pmid: 3485899
references.citation: Injury. 1976 Aug;8(1):53-9
references.pmid: 1002277
references.citation: J Trauma. 1982 Apr;22(4):291-4
references.pmid: 7077687
references.citation: Injury. 2009 Jan;40(1):40-3
references.pmid: 19117561
references.citation: J Trauma. 2008 Sep;65(3):549-53
references.pmid: 18784567
references.citation: J Emerg Med. 2001 Apr;20(3):281-4
references.pmid: 11267818
references.citation: Am Surg. 2007 Jun;73(6):569-72; discussion 572-3
references.pmid: 17658093
references.citation: Injury. 1985 Jan;16(4):247-8
references.pmid: 3967911
references.citation: Injury. 1980 May;11(4):331-5
references.pmid: 7409884
references.citation: Surg Gynecol Obstet. 1992 Sep;175(3):249-53
references.pmid: 1514160
references.citation: Surg Gynecol Obstet. 1989 Sep;169(3):223-5
references.pmid: 2772791
references.citation: Can J Surg. 2010 Aug;53(4):251-5
references.pmid: 20646399
references.citation: Eur J Emerg Med. 2009 Dec;16(6):305-11
references.pmid: 19417677
references.citation: J Emerg Med. 2010 Jul;39(1):105-12
references.pmid: 19157757