Blunt chest trauma: The role of chest x-ray, chest/abdomen computed tomography scan and physical examination

摘要

We read with great interest the recent report by Barrios et al showing that chest x-ray and abdominal computed tomography are sufficient to identify most clinically significant thoracic injuries in trauma patients, rendering thoracic computed tomography useful in only a subset of patients. Radiology plays a major role in the evaluation of trauma patients. Previously, the Advanced Trauma Life Support (ATLS) course recommended performing plain-film radiography of the chest, pelvis, and cervical spine in all patients with blunt trauma. However, in recent years, ATLS plain radiography of the cervical spine and pelvis has been limited to hemodynamically unstable patients or those with abnormal findings on physical examination, probably on the basis of previous evidence. On the other hand, most trauma centers in industrialized countries now use spiral computed tomography for evaluating the head, neck, chest, abdomen, and pelvis in trauma patients. The ATLS course still recommends chest radiography in all trauma patients. Recently, several studies have shown that chest radiography has limited value in the initial assessment of patients with blunt trauma who are hemodynamically stable or have negative findings on physical examination.