title: Retrospective review of the use and costs of routine chest x rays in a trauma setting.
abstract: BACKGROUND
  Chest x-rays (CXR) are routinely obtained on blunt trauma patients. Many patients also receive additional imaging with thoracic computed tomography scans for other indications. We hypothesized that in hemodynamically normal, awake and alert blunt trauma patients, CXR can be deferred in those who will also receive a TCT with significant cost savings.
  
  
  METHODS
  We retrospectively reviewed the charts of trauma patients from 1/1/2010 to 12/31/2010 who received both a CXR and TCT in the trauma room. Billing and cost data were collected from various hospital sources.
  
  
  RESULTS
  239 patients who met inclusion and exclusion criteria and received CXR and TCT between 1/1/2010 and 12/31/2010. The sensitivity of CXR was 19% (95% CI: 10.8% to 31%) and the specificity was 91.7% (95% CI: 86.7% to 95%). The false positive rate for CXR was 35.8% (95% CI: 21.7% to 52.8%) and the false negative rate was 24.5% (95% CI: 18.8% to 31.2%). The precision of CXR was 42.3% (95% CI: 25.5% to 61.1%) and the overall accuracy was 74.1% (95% CI: 68.1% to 79.2%). If routine chest xray were eliminated in these patients, the estimated cost savings ranged from $14,641 to $142,185, using three different methods of cost analysis.
  
  
  CONCLUSIONS
  In patients who are hemodynamically normal and who will be receiving a TCT, deferring a CXR would result in an estimated cost savings up to $142,185. Additionally, TCT is more sensitive and specific than CXR in identifying injuries in patients who have sustained blunt trauma to the thorax.
authors: Department of Surgery, Division of Trauma, Saint Francis Hospital and Medical Center, 114 Woodland St,, Hartford, CT 06103, USA. feeneymd@yahoo.com.
authors: Kristina
authors: K
authors: Ziegler
authors: James M
authors: JM
authors: Feeney
authors: Colleen
authors: C
authors: Desai
authors: David
authors: D
authors: Sharpio
authors: Wiiliam T
authors: WT
authors: Marshall
authors: Michael
authors: M
authors: Twohig
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