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Role of routine chest radiographs in the evaluation of patients with stable blunt chest trauma--a prospective analysis.
MedLine Citation:
PMID:  22808568     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVE: The study sought to assess the test performance characteristics of clinical judgement in the evaluation of stable blunt chest trauma patients compared with chest radiography (CXR) in the determination of significant intra-thoracic injury.
METHODS: We prospectively enrolled all adult patients (older than 16years) who were considered to have stable blunt chest trauma over a six-month period (May 1-October 31, 2009). We defined the latter as patients who were unintubated, normotensive (systolic blood pressure > 90 mm Hg) and without hypoxia (oxygen saturation> 95% at room air). Patients eligible for the study were sent for anteroposterior (AP) CXRs which were then interpreted by the same consultant radiologist throughout the study period. Both test (clinical judgement) and disease status (CXR) were assigned and correlated as binary measures. We compared the test performance characteristics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic likelihood ratios of clinical judgement to CXR findings in the determination of significant intra-thoracic injury.
RESULTS: During the six-month period, data were collected from 77 eligible stable blunt chest trauma patients (age over 16 years). Fifty-nine patients (76.6%) were male. Nine patients (11.7%) were radiologically confirmed to have significant blunt chest injuries including rib fractures, pneumothorax and an isolated case of pulmonary contusion. All nine (11.7%) patients had a positive (abnormal) radiograph for rib fractures. In addition, three (3.9%) of them also had both rib fracture and pneumothoraces and one (1.3%) had both a rib fracture and pulmonary contusion. Clinical judgementfor the diagnosis of significant blunt chest injuries matched with the CXR finding with 95% confidence intervals (CIs): sensitivity 100% (95% CI 66.4, 100), specificity 32.4% (95% CI 21.5, 44.8), prevalence 11.7%, PPV 16.4% (95% CI 7.77, 28.8), NPV100% (95% CI 84.6, 100), DLR+ 1.48 (95% CI 1.25, 1.74).
CONCLUSION: The majority ofpatients who sustained blunt chest injuries and were assessed as stable patients do not require CXR routinely. This study revealed that physicians in the local Emergency Department may be over-utilizing CXRfor patients who have stable blunt chest trauma.
Authors:
K S Myint; S French; J Williams-Johnson; E Williams; P Johnson; M O Reid; G Gordon-Strachan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The West Indian medical journal     Volume:  61     ISSN:  0043-3144     ISO Abbreviation:  West Indian Med J     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-07-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417410     Medline TA:  West Indian Med J     Country:  Jamaica    
Other Details:
Languages:  eng     Pagination:  64-72     Citation Subset:  IM    
Affiliation:
Department of Emergency Medicine, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica. kyawsoemyint@hotmail.com
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