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- Title
Criteria for the selective use of chest computed tomography in blunt trauma patients.
- Authors
Brink M; Deunk J; Dekker HM; Edwards MJ; Kool DR; van Vugt AB; van Kuijk C; Blickman JG; Brink, Monique; Deunk, Jaap; Dekker, Helena M; Edwards, Michael J R; Kool, Digna R; van Vugt, Arie B; van Kuijk, Cornelis; Blickman, Johan G
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>This observational study prospectively included consecutive patients (>or=16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre.<bold>Results: </bold>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 >or=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 >or=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.<bold>Conclusion: </bold>Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected.
- Publication
European Radiology, 2010, Vol 20, Issue 4, p818
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-009-1608-y