title: ACR appropriateness criteria blunt chest trauma.
abstract: Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: National Jewish Health, Denver, Colorado. Electronic address: jonherochung@yahoo.com.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Chung
authors.affiliation: National Jewish Health, Denver, Colorado.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Cox
authors.affiliation: Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Tan-Lucien H
authors.initials: TL
authors.lastname: Mohammed
authors.affiliation: Cleveland Clinic, Weston, Florida.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Kirsch
authors.affiliation: Ronald Regan UCLA Medical Center, Los Angeles, California.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Brown
authors.affiliation: National Jewish Health, Denver, Colorado.
authors.forename: Debra Sue
authors.initials: DS
authors.lastname: Dyer
authors.affiliation: Columbia University, New York, New York; Society of Thoracic Surgeons, Chicago, Illinois.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ginsburg
authors.affiliation: Indiana University, Indianapolis, Indiana.
authors.forename: Darel E
authors.initials: DE
authors.lastname: Heitkamp
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Kanne
authors.affiliation: University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Ella A
authors.initials: EA
authors.lastname: Kazerooni
authors.affiliation: University of New Mexico, Albuquerque, New Mexico.
authors.forename: Loren H
authors.initials: LH
authors.lastname: Ketai
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: James G
authors.initials: JG
authors.lastname: Ravenel
authors.affiliation: New York Methodist Hospital, Brooklyn, New York; American College of Chest Physicians, Northbrook, Illinois.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Saleh
authors.affiliation: North Shore University Hospital, Manhasset, New York.
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Shah
authors.affiliation: Temple University, Philadelphia, Pennsylvania.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Steiner
authors.affiliation: Ronald Regan UCLA Medical Center, Los Angeles, California.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Suh
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D013898:Thoracic Injuries / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000592:standards*; D014481:United States; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*
keywords: Appropriateness Criteria; CT; MRI; blunt trauma; chest radiography; echocardiography; ultrasound