title: Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas.
abstract: BACKGROUND
  Since the diagnostic yield of chest X-ray (CXR) is not high enough, when it is ordered for all the multiple trauma patients, this study was aimed to evaluate the relationship between clinical and CXR findings in order to formulate a clinical decision rule to prevent unnecessary CXR in these patients.
  
  
  METHODS
  Stable multiple blunt trauma patients referring to the ED were included. The clinical and radiographic findings of all the patients were collected and the relationships between these variables analysed. Finally, based on the regression coefficients (β) of the variables, the Thoracic Injury Rule-out Criteria (TIRC) were designed.
  
  
  RESULTS
  A total of 2607 patients were included (males: 78.9%, mean age: 34.1 ± 15.0 years). Age over 60 (β = 0.8; 95% CI: 0.27-1.34; P = 0.003), crepitation (β = 4.33; 95% CI: 1.65-7.0; P < 0.001), loss of consciousness (β = 3.16; 95% CI: 2.44-3.88; P < 0.001), decrease in pulmonary sounds (β = 2.67; 95% CI: 1.73-3.6; P < 0.001), chest wall pain (β = 2.12; 95% CI: 1.63-2.61; P < 0.001) and tenderness (β = 1.78; 95% CI: 1.26-2.27; P < 0.001), dyspnea (β = 1.3; 95% CI: 0.41-2.18; P = 0.004) and abrasion (β = 0.5; 95% CI: 0.22-0.83; P = 0.03) were independent factors predicting thoracic injury. CXR in stable conscious multiple blunt trauma patients under 60 years, without chest wall pain and tenderness, decrease in pulmonary sounds, crepitation, skin abrasion, and dyspnea did not provide any additional findings.
  
  
  CONCLUSIONS
  Based on TIRC, it seems that CXR in stable multiple blunt trauma patients who are conscious and under 60 and have no decrease in pulmonary sounds, no dyspnea, no thoracic skin abrasion, and no crepitation can be ignored.
authors.affiliation: Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Mehdi
authors.initials: MM
authors.lastname: Forouzanfar
authors.forename: Saeed
authors.initials: S
authors.lastname: Safari
authors.forename: Maryam
authors.initials: M
authors.lastname: Niazazari
authors.forename: Alireza
authors.initials: A
authors.lastname: Baratloo
authors.forename: Behrooz
authors.initials: B
authors.lastname: Hashemi
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Hatamabadi
authors.forename: Farhad
authors.initials: F
authors.lastname: Rahmati
authors.forename: Morteza
authors.initials: M
authors.lastname: Sanei Taheri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012044:Regression Analysis; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D019564:Unnecessary Procedures; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: clinical prediction rule; multiple traumas; patient selection; thoracic radiography