Abstract
Background
Although they infrequently lead to management changing diagnoses, chest x-rays (CXRs)
are the most commonly ordered imaging study in blunt trauma evaluation.
Objectives
To determine: 1) the reasons physicians order chest X-ray studies (CXRs) in blunt
trauma assessments; 2) what injuries they expect CXRs to reveal; and 3) whether physicians
can accurately predict low likelihood of injury on CXR.
Methods
At a Level I Trauma Center, we asked resident and attending physicians treating adult
blunt trauma patients: 1) the primary reason(s) for getting CXRs; 2) what, if any,
significant intrathoracic injuries (SITI) they expected CXRs to reveal; and 3) the
likelihood of these injuries. An expert panel defined SITI as two or more rib fractures,
sternal fracture, pulmonary contusion, pneumothorax, hemothorax, or aortic injury
on official CXR readings.
Results
There were 484 patient encounters analyzed—65% of participating physicians were residents
and 35% were attendings; 16 (3.3%) patients had SITI. The most common reasons for
ordering CXRs were: “enough concern for significant injury” (62.9%) and belief that
CXR is a “standard part of trauma work-up” (24.8%). Residents were more likely than
attendings to cite “standard trauma work-up” (mean difference = 13.5%, p = 0.003). When physicians estimated a < 10% likelihood of SITI on CXR, 2.1% (95%
confidence interval [CI] 1.0–4.1%) of patients had SITI; when they predicted a 10–25%
likelihood, 5.7% (95% CI 1.2–15.7%) had SITI; and when they predicted a > 25% likelihood,
9.1% (95% CI 3.0–20.0%) had SITI.
Conclusions
Physicians order CXRs in blunt trauma patients because they expect to find injuries
and believe that CXRs are part of a “standard” work-up. Providers commonly do not
expect CXRs to reveal SITI. When providers estimated low likelihood of SITI, the rate
of SITI was very low.
Keywords
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Article info
Publication history
Published online: November 07, 2011
Accepted:
June 11,
2011
Received in revised form:
May 16,
2011
Received:
February 7,
2011
Identification
Copyright
Published by Elsevier Inc.
