Routine Chest Computed Tomography and Hospital Admission Time and Complications in Patients with Blunt Trauma

Abstract

Background:Computerized Tomography (CT) scan is gaining more importance in the initial evaluation of patients with multiple trauma, but its effect on the outcome is still unclear. Until now, no prospective randomized trial has been performed to define the role of routine chest CT in patients with blunt trauma.Objectives:In view of the considerable radiation exposure and the high costs of CT scan, the aim of this study was to assess the effects of performing the routine chest CT on the outcome as well as complications in patients with blunt trauma.Patients and Methods:After approval by the ethics board committee, 100 hemodynamically stable patients with high-energy blunt trauma were randomly divided into two groups. For group one (control group), only chest X-ray was requested and further diagnostic work-up was performed by the decision of the trauma team. For group two, a chest X-ray was ordered followed by a chest CT, even if the chest X-ray was normal. Injury severity, total hospitalization time, Intensive Care Unit (ICU) admission time, duration of mechanical ventilation and complications were recorded. Data were evaluated using t-test, Man-Whitney and chi-squared test.Results:No significant differences were found regarding the demographic data such as age, injury severity and Glasgow Coma Scale (GCS). Thirty-eight percent additional findings were seen in chest CT in 26% of the patients of the group undergoing routine chest CT, leading to 8% change in management. The mean of in-hospital stay showed no significant difference in both groups with a P value of 0.098. In addition, the mean ICU stay and ventilation time revealed no significant differences (P values = 0.102 and 0.576, respectively). Mortality rate and complications were similar in both groups.Conclusions:Performing the routine chest CT in high-energy blunt trauma patients (with a mean injury severity of 9), although leading to the diagnosis of some occult injuries, has no impact on the outcome and does not decrease the in-hospital stay and ICU admission time. It seems that performing the routine chest CT in these patients may lead to overtreatment of nonsignificant injuries. The decision about performing routine CT scan in a trauma center should be made cautiously, considering the detriments and benefits.

Prevalence of Fractures and Diagnostic Accuracy of Emergency X-ray in Older Adults Sustaining a Low-Energy Fall: A Retrospective Study

“…However, in their study the diagnosis of rib fractures did not result in differences of the length of hospital stay, intensive care unit (ICU) admission rate or in-hospital mortality, which was remarkably higher-by 10.3%-in patients with CT-detected rib fractures [10]. Further studies on blunt trauma patients of every age have demonstrated that chest XR misses rib fractures and relevant intrathoracic injuries in blunt trauma patients of every age [27][28][29]. The proportion of undiagnosed rib fractures in chest XR ranges from 45% [29] to 74.5% (median three additional fractures in CT) [27].…”

“…The proportion of undiagnosed rib fractures in chest XR ranges from 45% [29] to 74.5% (median three additional fractures in CT) [27]. Intrathoracic injuries have been CT-identified in 26% of the cases [28], leading to changes in clinical management in 8% [28], respectively 34.5% [27] of the cases. Additionally, it has been demonstrated that mortality increases by 19% with each additional rib fracture in older patients with blunt trauma [30].…”

Delayed dorsal scapular artery hematoma following blunt thoracic trauma: a case report and review of the literature

“…This case illustrates how a low-dose contrast chest CT scan could be considered as a primary imagining tool in patients with suspected severe thoracic trauma such as a fall from heights. The decision to use an initial CT scan over chest radiography should always be made thoughtfully, considering benefits such as diagnosing occult life-threatening injuries as well as the disadvantages in terms of higher costs and radiation burden and the risk of overdiagnosis and overtreatment [ 7 ]. Most importantly CT chest should be the first choice if patients present with delayed complications after rib fractures, since chest radiography may miss a chest wall hematoma [ 5 ].…”

Radiologic diagnosis of pneumothorax in combat trauma

“…При цьому 37,5 % цих пацієнтів потребували операції за життєвими показаннями [14]. КТ краще виявляє забиті місця легень, пневмоторакс, переломи ребер і травми великих судин, забезпечуючи 38-81 % додаткових діагнозів порівняно з рентгенографією грудної клітки [15].…”