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,
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