Role of the trauma-room chest x-ray film in assessing the patient with severe blunt traumatic injury

Barry A. McLellan, MD, FRCPC; Jameel Ali, MD, MMedEd, FRCSC, FACS; Mark J. Towers, MB BCh, FRCPC; P. William Sharkey, MHK

Canadian Journal of Surgery 1996; 39: 36-41

From the Trauma Unit, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont.

Paper reprints of the full text may be obtained from: Dr. Barry A. McLellan, Suite C-135, Sunnybrook Health Science Centre, 2075 Bayview Ave., Toronto ON M4N 3M5
See also:
Trauma-room chest x-ray films

Abstract

Objectives: To examine the accuracy of standard trauma-room chest x-ray films in assessing blunt abdominal trauma and to determine the significance of missed injuries under these circumstances.
Design: A retrospective review.
Setting: A regional trauma unit in a tertiary-care institution.
Patients: Multiply injured trauma patients admitted between January 1988 and December 1990 who died within 24 hours of injury and in whom an autopsy was done.
Intervention: Standard radiography of the chest.
Main Outcome Measures: Chest injuries diagnosed and recorded by the trauma room team from standard anteroposterior x-ray films compared with the findings at autopsy and with review of the films by a staff radiologist initially having no knowledge of the injuries and later, if injuries remained undetected, having knowledge of the autopsy findings.
Results: Thirty-seven patients met the study criteria, and their cases were reviewed. In 11 cases, significant injuries were noted at autopsy and not by the trauma-room team, and in 7 cases these injuries were also missed by the reviewing radiologist. Injuries missed by the team were: multiple rib fractures (11 cases), sternal fractures (3 cases), diaphragmatic tear (2 cases) and intimal aortic tear (1 case). In five cases, chest tubes were not inserted despite the presence (undiagnosed) of multiple rib fractures and need for intubation and positive-pressure ventilation.
Conclusions: Significant blunt abdominal trauma, potentially requiring operative management or chest-tube insertion, may be missed on the initial anteroposterior chest x-ray film. Caution must therefore be exercised in interpreting these films in the trauma resuscitation room.
GO TO CJS: Feb. 1996 - GO TO Surgery and orthopedics
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