Trauma-room chest x-ray films

James P. Waddell, MD, FRCSC*

Canadian Journal of Surgery 1996; 39: 7

*Member, Editorial Board, Canadian Journal of Surgery. Director, Trauma Service, St. Michael's Hospital, University of Toronto, Toronto. Ont.

Paper reprints of the full text may be obtained from: Dr. Alan M. Graham, Associate professor and chief, Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, One Robert Wood Johnson Place, CN-19, New Brunswick NJ 083903-0019 USA

In this edition of the Journal (pages 36 to 41 [abstract]) McLellan and colleagues raise an important issue with regard to the quality and interpretation of emergency room chest x-ray films in patients suffering multiple trauma. Although the initial clinical assessment of the patient remains paramount in terms of the treatment of acute chest injuries, such as hemothorax or pneumothorax, there are many other conditions that depend upon the accurate interpretation of an anteroposterior chest x-ray film for diagnosis and subsequent management. In their paper, McLellan and colleagues report a relatively high rate of missed injuries despite their large volume of trauma patients, a skilled group of physicians constituting the trauma team and routine review of these films by a staff radiologist at some subsequent point. The types of injuries missed were significant; they included multiple rib fractures, sternal fractures, diaphragmatic rupture and intimal tear of the aorta.

The authors rightly point out the importance of good-quality films and good reproducible technique by the radiology technologist. There is simply no excuse for poor films in the trauma room, especially when their paper points out the high incidence of missed injuries and the potentially serious consequences of such missed injuries.

Quality control of imaging in the trauma room is often difficult because of the patient's condition, equipment, different physicians and technologists. However, it is incumbent, as evidenced in the article by McLellan and colleagues, that the trauma team leader be completely satisfied with the quality of the film and its interpretation before the patient leaves the trauma resuscitation room.

We should be grateful to these authors for undertaking such a critical review of their own performance, and we welcome their recommendations for improving our performance in similar circumstances. A concerted effort by all trauma team staff will almost certainly result in an improved level of quality in the chest x-ray films in trauma rooms.

CJS: Feb. 1996

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