• Logo
  • SBMUJournals

The Accuracy of Plain Radiography in Detection of Traumatic Intrathoracic Injuries

Maryam Abedi Khorasgani, Ali Shahrami, Majid Shojaee, Hossein Alimohammadi, Afshin Amini, Hamid Reza Hatamabadi

Abstract

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 injuries were as follows: sensitivity 50.3 (95% CI: 44.8 – 55.5), specificity 98.9 (95% CI: 99.5 – 99.8), PPV 97.8 (95% CI: 91.5 – 99.6), NPV 66.4 (95% CI: 60.2 – 72.03), PLR 44.5 (95% CI: 11.3 175.3), and NLR 0.5 (95% CI: 0.4 – 0.6). Accuracy of CXR in diagnosis of traumatic intrathoracic injuries was 74.5 (95% CI: 69.6 – 78.9) and its area under the ROC curve was 74.6 (95% CI: 69.3 – 79.8). Conclusion: The screening performance characteristics of CXR in diagnosis of traumatic intrathoracic injuries were higher than 90% in all pathologies except pneumothorax (50.3%). It seems that this matter has a great impact on the general screening characteristics of the test (74.3% accuracy and 50.3%sensitivity). It seems that, plain CXR should be used as an initial screening tool more carefully.

Keywords

X-Rays; radiography, thoracic; tomography, X-ray computed; diagnostic techniques and procedures; thoracic injuries

References

Khaji A, Ghodsi SM, Eftekhar B, Karbakhsh M. Trauma research in Iran: a report of the Sina Trauma Data Bank. Archives of Iranian medicine. 2010;13(1):17-20.

Mayberry JC. Imaging in thoracic trauma: the trauma surgeon's perspective. Journal of thoracic imaging. 2000;15(2):76-86.

Brink M, Kool D, Dekker H, et al. Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature. Clinical radiology. 2009;64(3):272-83.

Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of Blunt Thoracic Trauma 1. Radiographics. 2008;28(6):1555-70.

Scaglione M, Pinto A, Pedrosa I, Sparano A, Romano L. Multi-detector row computed tomography and blunt chest trauma. European journal of radiology. 2008;65(3):377-88.

Livingston DH, Shogan B, John P, Lavery RF. CT diagnosis of rib fractures and the prediction of acute respiratory failure. Journal of Trauma and Acute Care Surgery. 2008;64(4):905-11.

El Wakeel MA, Abdullah SM, El Khalek RSA. Role of computed tomography in detection of complications of blunt chest trauma. Menoufia Medical Journal. 2015;28(2):483.

Guerrero-López F, Vázquez-Mata G, Alcázar-Romero PP, Fernández-Mondéjar E, Aguayo-Hoyos E, Linde-Valverde CM. Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma. Critical care medicine. 2000;28(5):1370-5.

Renton J, Kincaid S, Ehrlich P. Should helical CT scanning of the thoracic cavity replace the conventional chest x-ray as a primary assessment tool in pediatric trauma? An efficacy and cost analysis. Journal of pediatric surgery. 2003;38(5):793-7.

Eckstein M, Henderson SO. Thoracic Trauma in Rosen’s Emergency Medicine. Philadelphia, Mosby Elsevier. 2010.

Exadaktylos A, Benneker L, Jeger V, et al. Total-body digital X-ray in trauma: an experience report on the first operational full body scanner in Europe and its possible role in ATLS. Injury. 2008;39(5):525-9.

Traub M, Stevenson M, McEvoy S, et al. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury. 2007;38(1):43-7.

Safari S, Baratloo A, Negida AS, Taheri MS, Hashemi B, Selkisari SH. Comparing the Interpretation of Traumatic Chest X-Ray by Emergency Medicine Specialists and Radiologists. Archives of trauma research. 2014;3(4).

Chardoli M, Hasan-Ghaliaee T, Akbari H, Rahimi-Movaghar V. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma. Chinese Journal of Traumatology. 2013;16(6):351-4.

Forouzanfar MM, Safari S, Niazazari M, et al. Clinical decision rule to prevent unnecessary chest X‐ray in patients with blunt multiple traumas. Emergency Medicine Australasia. 2014;26(6):561-6.

Rodriguez RM, Anglin D, Langdorf MI, et al. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA surgery. 2013;148(10):940-6.




DOI: http://dx.doi.org/10.22037/emergency.v4i4.10123

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.