title: Is Routine Spiral CT-Chest Justified in Evaluation of the Major Blunt Trauma Patients?
abstract: METHODS
  New generation spiral CT scanners permit multiple consecutive CT examinations on the same trauma patient in a short period of time. The purpose of this study was to evaluate the diagnostic role and therapeutic impact of routine spiral CT chest in multiply injured patients or patients with a suspicious mechanism of injury.
  
  
  METHODS
  This prospective study included 443 patients with blunt chest trauma. All patients underwent a spiral CT chest as part of their routine evaluation. Radiological interpretation of chest x-rays, CT scan findings, and changes in management plan guided by these findings were recorded.
  
  
  RESULTS
  The mechanism of injury was road traffic accidents in 422 patients (95.26%). Out of the 167 patients with normal chest radiograph, 136 (81.43%) were found to have an abnormality on chest CT. The management was changed in the form of additional investigations or unplanned intervention in 92 patients (20.76%). Additional investigations included transoesophageal echocardiography (n = 7), bronchoscopy (n = 13), transfer to higher center for aortography (n = 2). Intercostal tubes (n = 55), thoracotomies (n = 4), fixation of sternal fracture (n = 9), laparotomy (n = 1) and spinalfixation (n = 1) were performed following the CT scan.
  
  
  CONCLUSIONS
  Although the incidence of significant injuries identified by the chest CT scan was low, it did prompt immediate intervention in a significant number of patients; some of them had potentially life-threatening injuries. Routine use of CT scanning is warranted in early evaluation of polytrauma patients or patients with severe blunt chest trauma.
authors.affiliation: Thoracic Surgery Division, Padova University Hospital, Padova, Italy. mohn_hammad@yahoo.com.|Thoracic Surgery Division, Padova University Hospital, via Giustiniani 2, 35128, Padova, Italy. mohn_hammad@yahoo.com.
authors.forename: Abdel-Mohsen M
authors.initials: AM
authors.lastname: Hammad
authors.affiliation: Cardiothoracic Surgery Department, King Fahd Specialist Hospital, Buraidah, Al Qassim, Saudi Arabia.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Regal
keywords: Chest trauma; Computed tomography; Polytrauma
references.citation: J Korean Med Sci. 2004 Apr;19(2):159-66
references.pmid: 15082885
references.citation: Unfallchirurg. 2004 Oct;107(10):862-70
references.pmid: 15292959
references.citation: Am Surg. 1994 Jun;60(6):421-3
references.pmid: 8198332
references.citation: Clin Radiol. 2006 Apr;61(4):365-9
references.pmid: 16546467
references.citation: J Trauma. 1997 May;42(5):973-9
references.pmid: 9191684
references.citation: Radiology. 1992 Jun;183(3):663-6
references.pmid: 1584915
references.citation: Crit Care Med. 2000 May;28(5):1370-5
references.pmid: 10834680
references.citation: Thorac Surg Clin. 2007 Feb;17(1):1-9
references.pmid: 17650692
references.citation: Radiology. 2004 Sep;232(3):735-8
references.pmid: 15273333
references.citation: Chest Surg Clin N Am. 1997 May;7(2):199-211
references.pmid: 9156288
references.citation: Am J Surg. 1994 Dec;168(6):688-92
references.pmid: 7978020
references.citation: Surg Clin North Am. 1989 Feb;69(1):15-9
references.pmid: 2911786
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: Injury. 2007 Jan;38(1):43-7
references.pmid: 17045268
references.citation: J Trauma. 2001 Dec;51(6):1173-6
references.pmid: 11740271
references.citation: Eur Radiol. 2002 May;12 (5):969-78
references.pmid: 11976841
references.citation: J Trauma. 1997 Sep;43(3):405-11; discussion 411-2
references.pmid: 9314300
references.citation: J Trauma. 1998 Nov;45(5):922-30
references.pmid: 9820704
references.citation: J Trauma. 2004 Nov;57(5):1072-81
references.pmid: 15580035
references.citation: World J Surg. 2002 Jan;26(1):13-6
references.pmid: 11898027
references.citation: J Trauma. 1993 Aug;35(2):296-300; discussion 300-2
references.pmid: 8355312
references.citation: J Trauma. 1997 Jul;43(1):13-8
references.pmid: 9253901
references.citation: Arch Surg. 2006 May;141(5):468-73; discussion 473-5
references.pmid: 16702518