Thoracic computed tomography is an effective screening modality in patients with penetrating injuries to the chest.
BACKGROUND
The precise role of thoracic CT in penetrating chest trauma remains to be defined. We hypothesized that thoracic CT effectively screens hemodynamically normal patients with penetrating thoracic trauma to surgery vs. expectant management (NOM).


METHODS
A ten-year review of all penetrating torso cases was retrospectively analyzed from our urban University-based trauma center. We included hemodynamically normal patients (systolic blood pressure ≥90) with penetrating chest injuries that underwent screening thoracic CT. Hemodynamically unstable patients and diaphragmatic injuries were excluded. The sensitivity, specificity, positive predictive value and negative predictive value were calculated.


RESULTS
A total of 212 patients (mean injury severity score=24, Abbreviated Injury Score for Chest=3.9) met inclusion criteria. Of these, 84.3% underwent NOM, 9.1% necessitated abdominal exploration, 6.6% underwent exploration for retained hemothorax/empyema, 6.6% underwent immediate thoracic exploration for significant injuries on chest CT, and 1.0% underwent delayed thoracic exploration for missed injuries. Thoracic CT had a sensitivity of 82%, specificity of 99%, positive predictive value of 90%, a negative predictive value of 99%, and an accuracy of 99% in predicting surgery vs. NOM.


CONCLUSIONS
Thoracic CT has a negative predictive value of 99% in triaging hemodynamically normal patients with penetrating chest trauma. Screening thoracic CT successfully excludes surgery in patients with non-significant radiologic findings.
University of California, San Francisco-East Bay, Department of Surgery, 1411 East 31st Street, Oakland, CA, United States. Electronic address: Aaron.strumwasser@med.usc.edu.
Aaron
A
Strumwasser
University of California, San Francisco-East Bay, Department of Surgery, 1411 East 31st Street, Oakland, CA, United States. Electronic address: vincentchong@gmail.com.
Vincent
V
Chong
University of California, San Francisco-East Bay, Department of Surgery, 1411 East 31st Street, Oakland, CA, United States.
Eveline
E
Chu
University of California, San Francisco-East Bay, Department of Surgery, 1411 East 31st Street, Oakland, CA, United States. Electronic address: gregory.victorino@ucsfmedctr.org.
Gregory P
GP
Victorino
D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010490:Pericardial Effusion / Q000000981:diagnostic imaging* / Q000601:surgery; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014600:Utilization Review; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery
Computed tomography; Penetrating chest injury; Screening thoracic CT; Thoracic trauma