Professional Documents
Culture Documents
1
Thoracic Surgery Division, Padova University Hospital, Padova,
Italy,
2
Cardiothoracic Surgery Department, King Fahd Specialist Hospital,
Buraidah, Al Qassim, Saudi Arabia.
severity score (ISS) 16] [8]. (2) Isolated chest trauma More than half of patients 276 (62.3%) had a chest
with significant mechanisms of injury e.g., motor injury, diagnosed on X-ray film. Ninety-three percent of
vehicle crash, falls from heights greater than 3 m, or patients (n = 412) had at least one pathological finding
automobile, hitting a pedestrian . (3) Cases with assault on CT scan. Of the 167 (37.7%) with a normal chest
due to medicolegal reasons. radiograph, 136 patients (30.69%) were found to have an
Patients were assessed and managed along ATLS abnormality on chest CT. Seven percent of patients
guidelines [9]: primary survey, resuscitation, secondary (n = 31) had no abnormality on CT scan examination.
survey, including portable plain radiography of the Comparison of chest X-ray findings with those of
lateral cervical spine, chest and pelvis in the ED. the chest CT scan is presented in Table 1.
Necessary supportive treatments were commenced In this study, CT chest scanning was significantly
before transfer from the ED. Evaluation of the chest more effective in detecting pneumothorax, hemotho-
begins with assessment of the mechanism of injury, rax, hemo-pneumothorax, lung contusions and medi-
physical examination, and interpretation of chest astinal emphysema compared with a chest X-ray.
radiography. All patients underwent a CT chest, as Sternal fracture (p < 0.002) is detected better with CT
part of their evaluation. as well. Also CT scan was more effective in detecting
The following data were collected: patients demo- mediastinal hematoma, ruptured diaphragm and spinal
graphics, mechanisms of injury, clinical findings and and scapular fractures.
injuries sustained; interpretation of chest X-ray, CT In general, X-ray chest as compared to CT chest
scan findings, and changes in treatment based on these has a sensitivity of 66.9%, specificity of 100%, accuracy
findings and major operative procedures were recorded. of 69.3% and negative predictive value of 18.56%
An abnormal scan was defined as exhibiting any The clinical management was changed in 92 patients
traumatic abnormality. The intrathoracic findings (20.76%). Additional investigations and/or interventions
included pneumothorax, hemothorax, pulmonary con- following CT scan were performed and included
tusion, mediastinal abnormality suspicious for aortic transoesophageal echocardiography (n = 7), bronchos-
injury, mediastinal emphysema, rupture diaphragm and copy (n = 13) and patient transfer to higher center for
fracture of the ribs, scapula, sternum or dorsal spine. aortography (n = 2). Intercostal tubes were required in
Patient treatment changes were defined as altera- 55 patients following the CT scan for pneumothorax or
tions in the normal treatment plan as a direct result of the hemothorax that was not seen on a plain chest X-ray or
CT scan findings. These changes included performance for patient with mild hemo-pneumothorax undergoing
of additional diagnostic studies or interventions (e.g., general anesthesia or mechanical ventilation. Thoracot-
trans-esophageal echocardiography, angiography or omies were performed on four patients; three for rup-
bronchoscopy), and immediate operative intervention. tured diaphragm and one for a hemothorax and one
Comparison of data was performed by v2 test or laparotomy for ruptured diaphragm. Open fixation of
Fisher exact tests as appropriate. Statistical significance sternal fracture was performed in nine patients and
was considered at p < 0.05 for all comparisons. All dorsal spinal fixation in one patient.
statistical analyses were performed with SPSS version
13.0 (SPSS Inc, Chicago, IL). Table 1. Comparison between the chest X-ray and CT chest findings.