Comparing Interpretation of Traumatic Chest X-Ray by Emergency Medicine Specialists and Radiologists (original) (raw)
Related papers
The Accuracy of the First Chest X-Ray in the Trauma Patient
ANZ Journal of Surgery, 1990
Chest X-rays (CXR) are important in assessing chest traunia. This study assessed the accuracy ofthe first CXR in diagnosing moderate to severe chest injuries. One hundred patients presenting during 1985 and identified in the prospective Westmead Trauma Registry as having a chest injury with Abbreviated Injury Scale (AIS) scores of 3 or greater were included (ma1es:lemales =4.9:1; age range, 5-74 years). The ollicially reported interpretations of the first CXR were compared to the chest injuries finally diagnosed. In 19 of 77 survivors and 8 of 17 patients who had a CXR before dying, significant abnormalities (most commonly pneumothorax. haeniothorax, spinal and sternal injuries) were not diagnosed on CXR. Although erect CXR with posteroanterior (PA) and lateral projections are said to show accurately most major intrathoracic pathology, CXR of traunia patients are often taken supine. suboptinially. and soon after arrival, whereas chest injury may take time to become apparent. The limitations of mobile CXR must be appreciated, and inore formal CXR (anteroposterior and lateral) are advisable at a later stage if the clinical situation permits.
Emergency Medicine Investigations, 2017
Background: According to Advanced Trauma Life Support, chest radiography must be performed during the initial evaluation of patients with trauma. We studied the CXR performed in the emergency room of Rajaie Hospital to determine its usefulness. Methods: In this prospective study, patients who referred with high-energy trauma from December 2013 until April 2014 were recruited. Their demographic characteristics, including age, gender, and cause of trauma were recorded. Meticulous medical history was taken from all patients and they were examined by emergency medicine specialist. Simple radiographic CXR was performed for selective patients and image findings and their mediastinal width were recorded. All statistical analysis was performed using SPSS software version 20.0 and P-value less than 0.05 was considered significant. Results: Of the total 790 patients assessed, 137 patients were female (17.3%) and 655 were male (82.7%). Mean age of patients was 35.13±17.01 (ranging from 12 to 91); Mean mediastinal width was 80.9±11.45 mm (range: 49.2-142.29). The most common causes of trauma included car-to-patient accident in 131 patients (16.5%), motor-to-car accident in 128 patients (16.2%), car turnover in 103 (13%), falling down in 93 (11.7%), and stab wound 88 (11.1%). The most common pathologic finding included rib fractures (42.7%), pneumothorax (11.6%), abnormal diaphragmatic findings (10.3%), and hemothorax (8.3%). Conclusion: The results of the current study, in accordance to previous studies, suggest rib fractures, pneumothorax, abnormal diaphragmatic findings, and hemothorax as the most frequent findings in CXR that need to be assessed meticulously. Moreover, the majority of patients were young males and the most frequent causes of trauma included car accidents, falling down, and stab wound. Therefore, paying attention to their diagnosis and treatment may increase the survival of this important group of patients.
Necessity of Emergency Chest X-ray in a Patient with Multiple Trauma with Injury Severity Score >15
Eurasian Journal of Emergency Medicine, 2020
Thoracic trauma is the most important type of emergency traumas, which can cause complications. Accurate follow up of patients, repeated examinations and regular paraclinical tests are helpful in the prevention of serious complications in these patients. Regular and control thoracic radiographies are performed in many centers with interval of 6-8 hours to follow up complications in stable patients. There are different ideas about follow up procedure and interval between actions. Some believe that even 3 hours is adequate for monitoring in patients with asymptomatic penetrating trauma (4).
Emergency Medicine Journal, 2008
Background: Radiographs are vital diagnostic tools that complement physical examination in trauma patients. A study was undertaken to assess the performance of residents in emergency medicine in the interpretation of trauma radiographs. Methods: 348 radiographs of 100 trauma patients admitted between 1 March and 1 May 2007 were evaluated prospectively. These consisted of 93 cervical spine (C-spine) radiographs, 98 chest radiographs, 94 radiographs of the pelvis and 63 computed tomographic (CT) scans. All radiological material was evaluated separately by five emergency medicine residents and a radiology resident who had completed the first 3 years of training. The same radiographs were then evaluated by a radiologist whose opinion was considered to be the gold standard. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: The mean (SE) age of the patients was 29 (2) years (range 2-79). There were no statistically significant differences in terms of pathology detection between the emergency medicine residents and the radiologist. The agreement between the emergency medicine residents and the radiology resident was excellent for radiographs of the pelvis and the lung (kappa (k) = 0.928 and 0.863, respectively; p,0.001) and good for C-spine radiographs and CT scans (k = 0.789 and 0.773, respectively; p,0.001). Conclusions: Accurate interpretation of radiographs by emergency medicine residents who perform the initial radiological and therapeutic interventions on trauma patients is of vital importance. The performance of our residents was found to be satisfactory in this regard.
Journal of Research in Medical and Dental Science, 2019
Introduction: The Stable blunt chest trauma is a common reason for visiting emergency rooms. Patient history and careful clinical examination can provide information similar to CXR at a faster rate and with no complication. This study aimed to compare the results of radiography and clinical examination. Methodology: This prospective study conducted on 186 stable blunt trauma patients aged 16 and over. The acute injuries of the chest wall evaluated and compared in this study, included rib fracture, sternum fracture, flail chest, pneumothorax, hemothorax, and emphysema. The data were analysed using descriptive statistical tests. Findings: The mean age of patients participating in this study was 39.63 ± 14.95 years, and 125 patients (67.2%) were male. The most common pathologic finding in the patients’ CXR was rib fracture, observed in 45 patients (24.2%). A total of 54 patients had a positive finding and injury diagnosis in CXR, while the total number of positive cases in the clinical...
Chest X-rays in detecting injuries caused by blunt trauma
World journal of emergency medicine, 2016
The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarified at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma. A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009-2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists. Of the 447 patients, 309 (69.1%) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3%) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in det...
Provider Perceptions Concerning Use of Chest X-Ray Studies in Adult Blunt Trauma Assessments
The Journal of Emergency Medicine, 2012
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. Published by Elsevier Inc.
Introduction: Rapid diagnosis of traumatic intrathoracic injuries leads to improvement in patient management. This study was designed to evaluate the diagnostic value of chest radiography (CXR) in comparison to chest computed tomography (CT) scan in diagnosis of traumatic intrathoracic injuries. Methods: Participants of this prospective diagnostic accuracy study included multiple trauma patients over 15 years old with stable vital admitted to emergency department (ED) during one year. The correlation of CXR and CT scan findings in diagnosis of traumatic intrathoracic injuries was evaluated using SPSS 20. Screening characteristics of CXR were calculated with 95% CI. Results: 353 patients with the mean age of 35.2 ± 15.8 were evaluated (78.8% male). Age 16-30 years with 121 (34.2%), motorcycle riders with 104 (29.5%) cases and ISS < 12 with 185 (52.4%) had the highest frequency among patients. Generally, screening performance characteristics of chest in diagnosis of chest traumatic...