The impact of chest radiography on patient management in acute trauma care- observation from a level-1 trauma center.

Purpose: This study evaluates the impact of chest radiography on acute interventions in the trauma bay.

Methods: This cross-sectional study was performed on trauma patients admitted to the University Medical Center Utrecht, a level-1 trauma center, during a one-year period. All adult (≥ 16 years) trauma patients who underwent chest radiography in the trauma bay and were subsequently admitted to the hospital were eligible. Patients with non-blunt trauma, initial primary survey in another center, or initial chest radiography obtained outside the shock room were excluded. Patients were categorized as hemodynamically and respiratory compromised or non-compromised patients, and based on symptoms of chest injuries. Descriptive analyses were used.

Results: This study included 780 patients, with a median age of 51 years (IQR 32-68), and 66.2% were male. Comorbidities (ASA 3-4) were seen in 12.8% and the median ISS was 10 (IQR 5-18). There were 382 hemodynamically and respiratory non-compromised patients without symptoms of chest injuries, of whom 255 underwent a subsequent chest CT. No acute interventions were performed in these patients. In symptomatic but hemodynamically and respiratory non-compromised patients (n = 289) there were 15 (5.2%) non-urgent chest tube placements prior to CT. Among 109 hemodynamically or respiratory compromised patients there were 16 (14.7%) chest tube placements and five (4.6%) resuscitation surgeries prior to the chest CT.

Conclusion: Omission of chest radiography in hemodynamically and respiratory non-compromised trauma patients presenting in the trauma bay seems safe, provided that a chest CT is already indicated.