title: Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma.
abstract: BACKGROUND
  Thoracic injury rule out criteria (TIRC) were first introduced as a decision instrument for selective chest radiography in blunt thoracic trauma in 2014. However, the validity of this model has not been assessed in other studies. In this regard, the present survey evaluates the validity of TIRC model in a multi-center setting.
  
  
  METHODS
  In this cross-sectional study, clinical presentations and chest radiograms of multiple trauma patients referring to 6 educational hospitals in Iran were evaluated. Data were gathered prospectively during 2015. In each center, data collection and interpretation of radiograms were conducted by two different emergency medicine specialists. Measures were then taken for assessment of discriminatory power and calibration of the model.
  
  
  RESULTS
  Data from 2905 patients were gathered (73.17% were male; the mean age was 33.53 ± 15.42 years). Area under the receiver operating characteristics curve of the TIRC model for detection of thoracic traumatic injuries was 0.93 (95%CI: 0.93-0.94). Sensitivity and specificity of the model were 100 (98.91-100) and 67.65 (65.76-69.45), respectively. The intercept of TIRC calibration plot was 0.08 (95%CI: 0.07-0.09), and its slope was 1.19 (95%CI: 1.15-1.24), which are indicative of the model being perfect in detecting presence or absence of lesions in chest radiograms.
  
  
  CONCLUSIONS
  The findings are corroborative of external validation, good discrimination, and proper calibration of TIRC model in screening of multiple trauma patients for obtaining chest radiograms.
authors.affiliation: Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Safari
authors.affiliation: Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Yousefifard
authors.affiliation: Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Baikpour
authors.affiliation: Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Vafa
authors.initials: V
authors.lastname: Rahimi-Movaghar
authors.affiliation: Emergency Medicine Department, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Abiri
authors.affiliation: Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Masoomeh
authors.initials: M
authors.lastname: Falaki
authors.affiliation: Emergency Medicine Department, Urmia University of Medical Sciences, Urmia, IR, Iran.
authors.forename: Neda
authors.initials: N
authors.lastname: Mohammadi
authors.affiliation: Department of Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Parisa
authors.initials: P
authors.lastname: Ghelichkhani
authors.affiliation: Department of Emergency Medicine, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
authors.forename: Ali Moghadas
authors.initials: AM
authors.lastname: Jafari
authors.affiliation: Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Hosseini
keywords: Chest radiography; Scoring system; Thoracic trauma