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Panamerican Journal of Trauma, Critical Care & Emergency Surgery


Background: There is an excessive number of unnecessary chest X-rays (CXRs) in minor blunt trauma patients.

Objective: To identify, using routine clinical criteria, a subgroup of blunt trauma patients that do not require CXR for assessment.

Materials and methods: This was a retrospective analysis of trauma registry data collected over a 24-month period. Adult blunt trauma patients undergoing CXR on admission were analyzed. The following clinical criteria were assessed: Normal neurologic examination on admission (NNEx), hemodynamic stability (HS), normal physical examination of the chest on admission (NCEx), age = 60 years, and absence of distracting injuries (Abbreviated Injury Scale >2 in head, abdomen, and extremities). These clinical criteria were progressively merged to select a group with lowest risk of exhibiting abnormal CXR on admission.

Results: Out of 4,647 patients submitted to CXR on admission, 268 (5.7%) had abnormal findings on scans. Of 2,897 patients admitted with NNEx, 116 (4.0%) had abnormal CXR. Of 2,426 patients with NNEx and HS, 74 (3.0%) had abnormal CXR. Of 1,698 patients with NNEx, HS, and NCEx, 24 (1.4%) had abnormal CXR. Of 1,347 patients with NNEx, HS, NCEx, and age<60 years, 12 had thoracic injury (0.9% of total individuals receiving CXR). A total of 4 patients underwent chest drainage. Among 1,140 cases with all clinical criteria, 8 had confirmed thoracic injuries and 2 underwent chest drainage.

Conclusion: A subgroup of blunt trauma patients with low probability of exhibiting abnormalities on CXR at admission was identified. The need for CXR in this subgroup should be reviewed.

Keywords: Clinical protocols, Decision making, Emergency medical services, Multiple trauma, Practice guidelines as topic, Radiography, Thoracic.

How to cite this article: Pivetta LGA, Parreira JG, Below C, Rondini GZ, Perlingero JAG, Assef JC. Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria. Panam J Trauma Crit Care Emerg Surg 2017;6(1):30-34.

Source of support: Nil

Conflict of interest: None

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