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Article including Hoffman shows that 27% of scans deemed unnecessary, but this would have missed 17% of injuries (J Trauma 2009;67:779)
One clin prediction rule (Ann Emerg Med 2009;54:575)
have none:
GCS<14
costal margin tenderness
abd tenderness
femur fx
hematuria > or equal 25 rbc/hpf
hct<30
pneumo or rib fx on cxr
sens 95.8 (91-98) spec 29.9 (27.5-32.3)
Whole body ct shows survival benefit
Results: Sixty-eight patients (73.1%)
showed at least one pathologic sign on
chest radiograph, and 25 patients (26.9%)
had normal chest radiograph. In 13
(52.0%) of these 25 patients, the CT scan
showed multiple injuries; among these
were two aortic lacerations, three pleural
effusions, and one pericardial effusion.
Conclusion: Over 50% of patients
with normal initial chest radiograph
showed multiple injuries on the CT scan,
among which were also two (8%) potentially
fatal aortic lesions. We therefore
recommend primary routine chest CT
scan in all patients with major chest
trauma.
Key Words: Blunt chest trauma, Deceleration
trauma, Motor vehicle crash
(MVC), Fall from height, Undetected injuries,
Aortic lesion, Computed tomographic
(CT) scan, Chest radiograph.
J Trauma. 2001;51:1173–1176.
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