Derivation of a Decision Instrument for Selective Chest Radiography in Blunt Trauma

Abstract

We derived a DI consisting of seven clinical criteria that can identify SITI in blunt trauma patients with extremely high sensitivity. If validated, this instrument will allow for safe, selective chest imaging with potential resource savings.

Sternal fracture in the age of pan-scan

“…Inclusion criteria for both studies was as follows: (1) patients aged 14 years and above, (2) blunt trauma occurring within 24 h of emergency department (ED) presentation, and (3) receiving chest imaging (CXR or chest CT) in the ED as part of a trauma evaluation [14,15]. During these studies, we left all imaging decisions as to whether or not to perform CXR and chest CT up to providers without any input.…”

Diagnostic Yields, Charges, and Radiation Dose of Chest Imaging in Blunt Trauma Evaluations

“…3,14 To address imaging yield in terms of clinical relevance, we convened an expert trauma panel consisting of 10 associate professor level or higher trauma surgeons and emergency physicians, who defined, a priori, thoracic injuries seen on chest imaging as pneumothorax, hemothorax, aortic or great vessel injury, two or more rib fractures, ruptured diaphragm, sternal fracture, and pulmonary contusion or laceration. 12,13 We then generated a list of thoracic injuries seen on chest imaging paired with management changes and interventions (e.g., hemothorax with chest tube placement). Trauma expert panel members independently reviewed this list and assigned one of the following values to each injury/intervention pair: major clinical significance = 2 points, minor clinical significance = 1 point, and no clinical significance = 0 points.…”

“…In this regard, we derived a decision instrument that predicted intrathoracic injury in adult blunt trauma patients with high sensitivity. 12 As part of our subsequent validation study of this decision instrument, we planned to assess current blunt trauma chest imaging practice in terms of yields, financial considerations, and risks (predominantly radiation exposure) and thereby identify other trauma evaluation points (beyond the initial decision of whether to image or not to image) that would be most amenable to decision instrument development. Specifically, we sought to: 1) determine the diagnostic yields of individual components of chest imaging (CXR, chest CT, and chest CT after normal CXR) in adult blunt trauma patient evaluation, 2) estimate radiation exposure and hospital charges per injury identified with these three components, and 3) delineate trauma chest imaging assessment points for which selective chest imaging decision instruments would have the greatest effect (considering calculated yields, estimated charges, and radiation dose per injury diagnosed of the three chest imaging components).…”

Yield and Clinical Predictors of Thoracic Spine Injury from Chest Computed Tomography for Blunt Trauma

“…For 2 of our 3 predictive factors, AMS and DPI, Kappa values were >0.5 indicating good inter-rater reliability, while T-spine tenderness was not assessed. 12 We conducted this single-center, prospective cohort derivation study at a high-volume (3,600 trauma activations per year) urban United States American College of Surgeonsverified Level I Trauma Center over 13 months from November 2011 to December 2012. These patients were a subset of 2 larger studies to validate and derive decision instruments for chest radiograph and CCT.…”