Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Diagnostic Usefulness of Computed Tomography Compared to Conventional Chest X-Ray for Chest Trauma Patients

흉부 외상 환자에서 일반흉부촬영과 비교한 흉부단층촬영의 진단적 유용성

  • Choi, Kyu Ill (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Seo, Kang Suk (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Ryoo, Hyun Wook (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Park, Jung Bae (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Chung, Jae Myung (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Ahn, Jae Yoon (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Kang, Seong Won (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Yi, Jae Hyuck (Department of Radiology, College of Medicine, Kyungpook National University)
  • 최규일 (경북대학교 의과대학 응급의학교실) ;
  • 서강석 (경북대학교 의과대학 응급의학교실) ;
  • 류현욱 (경북대학교 의과대학 응급의학교실) ;
  • 박정배 (경북대학교 의과대학 응급의학교실) ;
  • 정제명 (경북대학교 의과대학 응급의학교실) ;
  • 안재윤 (경북대학교 의과대학 응급의학교실) ;
  • 강성원 (경북대학교 의과대학 응급의학교실) ;
  • 이재혁 (경북대학교 의과대학 영상의학교실)
  • Received : 2009.07.17
  • Accepted : 2009.11.25
  • Published : 2009.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT. Methods: This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients' characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present. Results: Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn' be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR. Conclusion: CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn' be found on CXR to be verified, which helped us to could accurately evaluate patients.

Keywords

References

  1. Kulshrestha P, Munshi I, Wait R. Profile of chest trauma in a level Ⅰ trauma center. J Trauma 2004;57:576-81 https://doi.org/10.1097/01.TA.0000091107.00699.C7
  2. Schild HH, Strunk H, Weber W, Stoerkel S, Doll G, Hein K et al. Pulmonary contusion: CT vs. plain radiograms. J Comput Assist Tomogr 1989;13:417-20 https://doi.org/10.1097/00004728-198905000-00008
  3. Exadaktylos AK, Sclabas G, Schmid SW, Schaller B, Zimmermann H, Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with "normal" chest radiograph? J Trauma 2001;51:1173-6 https://doi.org/10.1097/00005373-200112000-00025
  4. Deunk J, Dekker HM, Brink M, van Vugt R, Edwards MJ, van Vugt AB, The value of indicated computed tomography scan of the chest and abdomen in addition to the conventional radiologic work-up for blunt trauma patients, J Trauma 2007;63:757-63 https://doi.org/10.1097/01.ta.0000235878.42251.8d
  5. Woo KH, Kim WU, Kim KH, Kim HY, Lee GJ. The efficacy of computed tomography in patients of chest trauma. J Korean Soc Emerg Med 1999;10:91-5
  6. Marshall GB, Farnquist BA, MacGregor JH, Burrowes PW. Signs in thoracic Imaging. J Thorac Imaging 2006;21:76-90 https://doi.org/10.1097/01.rti.0000189192.70442.7a
  7. Poole GV, Morgan DB, Cranston PE, Muakkassa FF, Griswold JA, Computed tomography in the management of blunt thoracic trauma. J Trauma 1993;35:296-302 https://doi.org/10.1097/00005373-199308000-00021
  8. Trupka, A, Waydhas C, Hallfeldt KK, Nast-kolb D, Pfeifer KJ. Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: Results of a prospective study. J Trauma 1997;43:405-12 https://doi.org/10.1097/00005373-199709000-00003
  9. Karaaslan T, Meuli R, Andox R, Duvoisin B, Hessler C, Schnyder P. Traumatic chest lesions in patients with severe head Trauma: A comparative study with computed tomography and conventional roentgenorams. J Trauma 1995;39:1081-6 https://doi.org/10.1097/00005373-199512000-00012
  10. Kim JJ, Shin JH, Jin W, Hyun SY, Lim YS, Yang HJ et al. The value of Grading of Pulmonary Contusion by the Chest CT Scanning. J Korean Soc Emerg Med 2004;15:452-5
  11. Traub M, Stevenson M, McEvoy S, Briggs G, Lo SK, Leibman S et al. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury 2007;38:43-7 https://doi.org/10.1016/j.injury.2006.07.006
  12. Pillgram-Larssen J, Lovstakken K, Hafsahl G, Solheim K. Initial axial computerized tomography examination in chest injuries. Injury 1993;24:182-4 https://doi.org/10.1016/0020-1383(93)90289-I
  13. Thoongsuwan N, Kanne JP, Stern EJ. Spectrum of blunt chest injuries. J Thorac Imaging 2005;20:89-97 https://doi.org/10.1097/01.rti.0000148210.89718.f5
  14. McLellan BA, Towers MJ, Sharkey W. Role of the trauma-room chest x-ray film in assessing the patient with severe blunt traumatic injury. Can J Surg 1996;39:36-41
  15. Mirvis SE, Bidwell JK, Buddemeyer EU, Diaconis JN, Pais SO, Whitley JE et al. Value of chest radiography in excluding traumatic aortic rupture. Radiology 1987;163:487-93 https://doi.org/10.1148/radiology.163.2.3562831
  16. Demetriades D, Gomez H, Velmahos GC, Asensio JA, Murray J, Cornwell EE 3rd et al. Routine helical computed tomographic evaluation of the mediastinum in high risk blunt trauma patients. Arch Surg 1998;133:1084-8 https://doi.org/10.1001/archsurg.133.10.1084
  17. Plurad D, Green D, Demetriades D, Rhee P. The Increasing use of Chest Computed Tomography for Trauma: Is it being overutilized? J Trauma 2007;62:631-5 https://doi.org/10.1097/TA.0b013e31802bf009
  18. Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S et al. Elderly Trauma Patients with Rib Fractures Are at Greater Risk of Death and Pneumonia. J Trauma 2003;54:478-85 https://doi.org/10.1097/01.TA.0000037095.83469.4C
  19. Ahn SK, LEE G, Yang HJ, Ryou E, Park CW. Predictors of pulmonary complications and mortality in blunt chest trauma. J Korean Soc Emerg Med 1999;9:129-34
  20. Tyburski JG, Collinge JD, Wilson RF, Eachempati SR. Pulmonary contusions quantifying the lesions on chest x-ray films and the factors affecting prognosis. J Trauma 1999;46:833-8 https://doi.org/10.1097/00005373-199905000-00011
  21. Collins J. Chest wall trauma. J Thorac Imaging 2000;15:112-9 https://doi.org/10.1097/00005382-200004000-00006