Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 6 , ISSUE 1 ( January-April, 2017 ) > List of Articles

RESEARCH ARTICLE

Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria

Luca GA Pivetta, Cristiano Below, Giovanna Z Rondini, Jacqueline AG Perlingero, José C Assef, José G Parreira

Citation Information : Pivetta LG, Below C, Rondini GZ, Perlingero JA, Assef JC, Parreira JG. Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria. Panam J Trauma Crit Care Emerg Surg 2017; 6 (1):30-34.

DOI: 10.5005/jp-journals-10030-1169

License: CC BY 3.0

Published Online: 01-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

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.

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.

Objetivo

identificar, baseados em critérios clínicos, um grupo de vítimas de trauma fechado com baixa probabilidade de apresentar alterações na radiografia simples de tórax à admissão (RXT).

Materiales y métodos

Análise retrospectiva dos dados de registro de trauma em um período de 24 meses entre 2008 e 2010. Foram selecionados adultos vítimas de trauma fechado que realizaram RXT à admissão. Avaliamos as seguintes variáveis clínicas: exame neurológico normal à admissão (ExNN), estabilidade hemodinâmica (EH), exame físico de tórax normal à admissão (ExTN), idade inferior a 60 anos (ID<60) e ausência de lesões distrativas (ALD) (AIS>2 cabeça, abdome, extremidades). Estes critérios clínicos foram progressivamente sobrepostos para selecionar um grupo com a menor probabilidade de apresentar uma RXT anormal à admissão.

Resultados

Foram incluídos 5536 vítimas de trauma fechado, sendo que 302 (5,5%) apresentaram lesões torácicas. Dos 4647 que foram submetidos a RXT na admissão, 268 (5,7%) apresentaram um achado anormal no exame. Dos 2897 admitidos com ExNN, 116 (4,0%) tinham RXT alteradas. Dos 2426 com ExNN e EH, 74 (3,0%) apresentaram alteração na RXT. Dos 1698 com ExNN, EH e ExTN, 24 (1,4%) apresentaram RXT alterada. Dos 1347 com ExNN, EH, ExTN e ID<60, 19 (1,4%) tinham RXT alterada. Doze dos 19 pacientes possuíam uma lesão torácica com AIS>1 confirmada (0,9% do total de indivíduos que realizaram RXT). As lesões identificadas foram: fratura de costela (9), pneumotórax(3), hemotórax(1). Quatro pacientes necessitaram de drenagem torácica. Dos 1140 casos com ExNN, EH, ExTN, ID<60 e ALD, foram identificadas 9 (0,8%) RXT alteradas, com 8 lesões torácicas confirmadas e dois casos que necessitaram de drenagem de tórax (0,2%).

Conclusão

É possível identificar um subgrupo de vítimas de trauma fechado com baixa probabilidade de apresentar alterações à RXT à admissão. A necessidade da RXT neste subgrupo deve ser revista.


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