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European Radiology
Published in: European Radiology 4/2010

Open Access 01-04-2010 | Emergency Radiology

Criteria for the selective use of chest computed tomography in blunt trauma patients

Authors: Monique Brink, Jaap Deunk, Helena M. Dekker, Michael J. R. Edwards, Digna R. Kool, Arie B. van Vugt, Cornelis van Kuijk, Johan G. Blickman

Published in: European Radiology | Issue 4/2010

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Abstract

Purpose

The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury.

Methods

This observational study prospectively included consecutive patients (≥16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre.

Results

We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age ≥55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <−3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with ≥1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant.

Conclusion

Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected.
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Metadata
Title
Criteria for the selective use of chest computed tomography in blunt trauma patients
Authors
Monique Brink
Jaap Deunk
Helena M. Dekker
Michael J. R. Edwards
Digna R. Kool
Arie B. van Vugt
Cornelis van Kuijk
Johan G. Blickman
Publication date
01-04-2010
Publisher
Springer-Verlag
Published in
European Radiology / Issue 4/2010
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-009-1608-y

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