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Salmon E, Oliver M, Bein K, Berry M, Partyka C, Seimon R, Singh H, Dinh M. Long-term trends in incidence and outcomes of rib fractures: A population-based data linkage study from New South Wales, Australia. Emerg Med Australas 2024. [PMID: 39049201 DOI: 10.1111/1742-6723.14469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/24/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Determine long-term trends in population-based incidence and outcomes of rib fracture hospitalisations. METHODS This was a data linkage study of rib fracture cases identified between 2015 and 2022 in New South Wales, Australia. Routinely collected health data were linked between ED, admitted patient and death registry data collection. The primary outcomes were age-specific incidence of rib fracture hospitalisation cases and risk-adjusted 30 days mortality. Other outcomes of interest were hospital length of stay (LOS), admission rate and ICU admissions. RESULTS A total of 70 609 cases were analysed. Overall, the number of rib fracture hospitalisations increased by 25% between 2015 and 2022. The highest proportion of cases was in the 45-65 years (28%) and 65-85 years (31%) age groups. On a per population basis, the incidence rate increased by 2% per annum. After adjusting for age, comorbidity and injury severity, there was no significant trend in 30 days mortality observed between 2015 and 2022. The median inpatient LOS was 4 days with 38% of patients staying 1-2 days. Regional and rural areas were associated with more severe chest injuries. CONCLUSION Rib fracture hospitalisations have increased with older patients driving this trend.
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Affiliation(s)
- Eliot Salmon
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Matthew Oliver
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kendall Bein
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Melanie Berry
- Sydney Local Health District, Sydney, New South Wales, Australia
- Western NSW Local Health District, Dubbo, New South Wales, Australia
| | - Christopher Partyka
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Radhika Seimon
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hardeep Singh
- NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Michael Dinh
- Sydney Local Health District, Sydney, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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2
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L'Huillier JC, Carroll HL, Zhao JY, Jalal K, Yu J, Guo WA. Plain Chest Film Versus Computed Tomography of the Chest as the Initial Imaging Modality for Blunt Thoracic Injury. Am Surg 2024:31348241260267. [PMID: 39030704 DOI: 10.1177/00031348241260267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
BACKGROUND While chest X-ray (CXR) is an efficient tool for expeditious detection of life-threatening injury, chest computed tomography (CCT) is more sensitive albeit with added time, cost, and radiation. Thus far, there is limited evidence and lack of consensus on the best imaging practices. We sought to determine the association between imaging modality and outcomes in isolated blunt thoracic trauma. METHODS The 2017-2020 TQIP database was queried for adult patients who sustained isolated blunt chest trauma and underwent chest imaging within 24 hours of admission. Patients who underwent CCT were 2:1 propensity-score-matched to those who underwent CXR. The primary outcome was mortality, and the secondary outcomes were hospital and ICU length of stay (LOS), ICU admission, need for and days requiring mechanical ventilation, complications, and discharge location. RESULTS Propensity score matching yielded 17 716 patients with CCT and 8861 with CXR. While bivariate analysis showed lower 24-hr (CCT .2% vs CXR .4%, P = .0015) and in-hospital mortality (CCT 1.2% vs CXR 1.5%, P = .0454) in the CCT group, there was no difference in survival probability between groups (P = .1045). A higher percentage of CCT patients were admitted to the ICU (CCT 26.9% vs CXR 21.9%, P < .0001) and discharged to rehab (CCT .8% vs CXR .5%, P = .0178). DISCUSSION CT offers no survival benefit over CXR in isolated blunt thoracic trauma. While CCT should be considered if clinically unclear, CXR likely suffices as an initial screening tool. These findings facilitate optimal resource allocation in constrained environments.
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Affiliation(s)
- Joseph C L'Huillier
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Division of Health Services, Policy, and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Hannah L Carroll
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jane Y Zhao
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Kabir Jalal
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Jihnhee Yu
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Weidun A Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Cheng CT, Kuo LW, Ouyang CH, Hsu CP, Lin WC, Fu CY, Kang SC, Liao CH. Development and evaluation of a deep learning-based model for simultaneous detection and localization of rib and clavicle fractures in trauma patients' chest radiographs. Trauma Surg Acute Care Open 2024; 9:e001300. [PMID: 38646620 PMCID: PMC11029226 DOI: 10.1136/tsaco-2023-001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Purpose To develop a rib and clavicle fracture detection model for chest radiographs in trauma patients using a deep learning (DL) algorithm. Materials and methods We retrospectively collected 56 145 chest X-rays (CXRs) from trauma patients in a trauma center between August 2008 and December 2016. A rib/clavicle fracture detection DL algorithm was trained using this data set with 991 (1.8%) images labeled by experts with fracture site locations. The algorithm was tested on independently collected 300 CXRs in 2017. An external test set was also collected from hospitalized trauma patients in a regional hospital for evaluation. The receiver operating characteristic curve with area under the curve (AUC), accuracy, sensitivity, specificity, precision, and negative predictive value of the model on each test set was evaluated. The prediction probability on the images was visualized as heatmaps. Results The trained DL model achieved an AUC of 0.912 (95% CI 87.8 to 94.7) on the independent test set. The accuracy, sensitivity, and specificity on the given cut-off value are 83.7, 86.8, and 80.4, respectively. On the external test set, the model had a sensitivity of 88.0 and an accuracy of 72.5. While the model exhibited a slight decrease in accuracy on the external test set, it maintained its sensitivity in detecting fractures. Conclusion The algorithm detects rib and clavicle fractures concomitantly in the CXR of trauma patients with high accuracy in locating lesions through heatmap visualization.
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Affiliation(s)
- Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chun-Hsiang Ouyang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chi-Po Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Wei-Cheng Lin
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Shih-Ching Kang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
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Navarro SM, Solaiman RH, Zhang J, Diaz-Gutierrez I, Tignanelli C, Harmon JV. Incidence of adult rib fracture injuries and changing hospitalization practice patterns: a 10-year analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02519-6. [PMID: 38592464 DOI: 10.1007/s00068-024-02519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Rib fractures are common after blunt thoracic trauma and can be associated with significant morbidity and mortality. We investigated trends of rib fracture injuries among adults presenting to United States (US) emergency departments, factors related to increased likelihood of hospitalization, and hospitalization practice patterns. METHODS We queried the National Electronic Injury Surveillance System database between 2012 and 2021 for all patients 18 years of age and older with rib fractures. These data were extrapolated to provide national estimates. Regression analysis was performed to identify trends for injury and risk factors for hospitalization. RESULTS We identified 32,233 adult patients with rib fractures; this extrapolated to a national estimate of 1,430,270 patients with rib fractures during the 10-year period. Between 2012 and 2021, there was a 52% increase in the incidence rate per 100,000 persons (R2 = 0.94, p < 0.001). Males accounted for 58% of patients with rib fractures, and 50% of patients were 65 years or older. Hospitalization was required in 38% of patients, and the hospitalization rate increased by 96% during the study period (R2 = 0.96, p < 0.001). When comparing hospitals of different sizes, a 20% greater increase in the odds of hospitalization over time was identified among patients presenting to "larger" hospitals compared to "smaller" hospitals. CONCLUSION The incidence of rib fractures and the associated hospitalization rates are both increasing nationally, with half of cases occurring in patients aged 65 years or older. Our findings emphasize the urgent need to implement evidence-based preventive measures and current management guidelines when managing the increasing caseload of rib fracture injuries.
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Affiliation(s)
- Sergio M Navarro
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
- Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | | | | | - Ilitch Diaz-Gutierrez
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Division of Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - James V Harmon
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Flaaten N, Moslim H, Tang E, Varrall R. Scapular fractures: A regional and rural perspective. Aust J Rural Health 2024; 32:388-393. [PMID: 38480988 DOI: 10.1111/ajr.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective. OBJECTIVE The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre. DESIGN The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries. FINDINGS One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma. DISCUSSION A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world. CONCLUSION Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.
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Affiliation(s)
- Nordan Flaaten
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopedic Department, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Huissan Moslim
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Eric Tang
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Ruth Varrall
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
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Tieu A, Kroen E, Kadish Y, Liu Z, Patel N, Zhou A, Yilmaz A, Lee S, Deyer T. The Role of Artificial Intelligence in the Identification and Evaluation of Bone Fractures. Bioengineering (Basel) 2024; 11:338. [PMID: 38671760 PMCID: PMC11047896 DOI: 10.3390/bioengineering11040338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Artificial intelligence (AI), particularly deep learning, has made enormous strides in medical imaging analysis. In the field of musculoskeletal radiology, deep-learning models are actively being developed for the identification and evaluation of bone fractures. These methods provide numerous benefits to radiologists such as increased diagnostic accuracy and efficiency while also achieving standalone performances comparable or superior to clinician readers. Various algorithms are already commercially available for integration into clinical workflows, with the potential to improve healthcare delivery and shape the future practice of radiology. In this systematic review, we explore the performance of current AI methods in the identification and evaluation of fractures, particularly those in the ankle, wrist, hip, and ribs. We also discuss current commercially available products for fracture detection and provide an overview of the current limitations of this technology and future directions of the field.
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Affiliation(s)
- Andrew Tieu
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ezriel Kroen
- New York Medical College, Valhalla, NY 10595, USA
| | | | - Zelong Liu
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nikhil Patel
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexander Zhou
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | | | - Timothy Deyer
- East River Medical Imaging, New York, NY 10021, USA
- Department of Radiology, Cornell Medicine, New York, NY 10021, USA
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7
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Wasfie T, Hardy R, Naisan M, Hella J, Barber K, Yapchai R, Memar S, Megaly M, Shapiro B. Value of Thoracic CT in Blunt Trauma Patients With High Glasgow Coma Scale and Low Injury Severity Scale. Am Surg 2023; 89:5678-5681. [PMID: 37118989 DOI: 10.1177/00031348231173423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To determine the value of ordering a routine chest CT (CCT) in patients with blunt trauma presenting to the emergency department with a high GCS and low ISS, we retrospectively collected patient data including CT scan results, when physical examination and initial chest X-ray were normal in the trauma bay area. METHODS A retrospective data collection of 901 consecutive blunt trauma patients seen in the ED between 2017 and 2019 was analyzed. Data included physical examination, age, gender, current use of anticoagulation therapy, comorbid conditions, as well as the result of radiologic images, hospital length of stay, surgical intervention, and mortality. The patients were divided into two groups: group one (patients with negative physical examination; chest x-ray and CT) and group 2 (negative physical examination, positive or negative chest x-ray, and positive CT). Statistical analysis was performed using student's t-test and chi-square test. RESULTS Of the 901 patients there were 489 (54%) males and 412 (46%) females with a mean age of 56 years. There were 461 patients who had a physical examination, chest x-ray, abdominal and CCT done. Group one included 442 (96%) patients, with negative physical examination, negative chest X-ray and CT scan. In group 2, 19 (4%) patients who had positive CT and or chest x-ray. Both groups were similar in GCS and ISS. Of the 19 patients, sixteen patients had a positive CCT, and thirteen of those had a positive chest x-ray. In the three patients who had negative physical examination and chest x-ray, the CT findings included one with a nondisplaced 10th rib fracture and two patients with osteoporotic compression fractures of dorsal vertebrae. The rate of both chest x-ray and CCT being positive among a group of screened patients was 16% (3/19) and the rate of a negative chest x-ray but positive CT was 16% (3/19). The odds ratio between the two outcomes was one. CONCLUSION In blunt trauma patients presenting to the ED with a high GCS and low ISS score, when initial physical examination and chest x-ray are negative, routine CCT is of little value.
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Affiliation(s)
- Tarik Wasfie
- Department of Trauma and General Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Rachel Hardy
- Department of Trauma and General Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | | | - Jennifer Hella
- Department of Academic Research, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Kimberly Barber
- Department of Academic Research, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Raquel Yapchai
- Department of Trauma and General Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Shayan Memar
- Kirkville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Maher Megaly
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Brian Shapiro
- Department of Trauma and General Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
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Yen MH, Liu TH, Liu JS, Yim S. Use of robotic C-arm cone-beam computed tomography in surgical stabilization of rib fractures. Injury 2023; 54:111087. [PMID: 37858443 DOI: 10.1016/j.injury.2023.111087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION The effectiveness of using intraoperative robotic C-arm cone-beam computerized tomography (CT) to locate rib fractures during surgery was compared to using pre-operative CT. METHODS Patients diagnosed with multiple rib fracture and treated surgically in the hospital between January 2019 and September 2020 were included. The study included two groups of patients. One group had their rib fractures identified using pre-operative CT, while the other group had their fractures localized using intraoperative cone-beam CT during surgery. The operative time, blood loss, number of incisions, length of incision, duration of chest drains, visual analogue scale (VAS) score, and duration of post-operation stays were measured. RESULTS A total of 12 patients received intraoperative cone-beam CT, while the remaining 18 patients only received pre-operative CT. Statistical analysis showed that the group treated with cone-beam CT had lower blood loss (p = 0.012), shorter incisions (p = 0.005), and better post-operation VAS scores (p = 0.027). There were also non-significant trends towards fewer incisions, shorter operation times, and shorter duration of chest drains in the group treated with cone-beam CT. CONCLUSIONS Intraoperative localization of rib fracture sites with cone-beam CT is an effective method for rib fracture stabilization.
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Affiliation(s)
- Ming-Hong Yen
- Department of Chest Surgery, Cathay General Hospital, Taipei City 10630, Taiwan
| | - Tsu-Hao Liu
- Department of Chest Surgery, Cathay General Hospital, Taipei City 10630, Taiwan
| | - Jung-Sen Liu
- Department of Chest Surgery, Cathay General Hospital, Taipei City 10630, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
| | - Shelly Yim
- Department of Chest Surgery, Cathay General Hospital, Taipei City 10630, Taiwan.
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Okoye OG, Gwaram UA, Olaomi OO, Adamu YB, Apollo DK. Analysis of diagnoses of chest injuries in a Nigerian trauma center. Niger J Clin Pract 2023; 26:1134-1138. [PMID: 37635607 DOI: 10.4103/njcp.njcp_30_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Chest injury is one of the most common types of trauma-related injuries accounting for about 10% of trauma admissions in emergency services. The injuries may be immediate, life-threatening, or potentially life-threatening based on diagnosis after initial assessment. This study is intended to analyze the pattern of diagnosis found in chest-injured patients in a trauma center of a developing country. Methods This is a retrospective study carried out in the trauma center of the National Hospital Abuja, Nigeria, between January 2015 and December 2017, as an analysis of the existing trauma registry. Data procession was done using SPSS version 24.0. Results were presented in tables and figures. Results A total of 637 patients' data was studied, male to female ratio of 3.58 and mean age of 34.18 ± 11.34 years. More patients sustained isolated chest injury (59.5%) and blunt chest injury (78%). The most frequent diagnosis was chest wall soft tissue injury (CWSTI) (46.6%) despite the exclusion of minor chest wall injuries who did not require any form of observation. Haemothorax and rib fractures were the next most common diagnoses after CWSTI constituting 13.5% and 8.7%, respectively, while flail chest and aortic injuries were the least comprising 0.6% and 0.2%, respectively. The commonest associated injuries were traumatic brain injury (11.3%), extremity fractures (11.1%), and abdominal injuries (7.8%). Penetrating injuries were more significantly associated with male gender and isolated chest injuries (P < 0.001). Conclusion Chest wall soft tissue injuries constitute a large proportion of chest injuries seen in our setting. Despite its relatively low importance in the medical literature, it should be given attention in resource-poor settings in order to minimize missed significant injuries in the absence of diagnostic facilities. Therefore, high index of suspicion and low threshold for observation should be practiced in this group of patients.
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Affiliation(s)
- O G Okoye
- Department of Surgery, National Hospital Abuja, Abuja, Nigeria
| | - U A Gwaram
- Department of Surgery, National Hospital Abuja, Abuja, Nigeria
| | - O O Olaomi
- Department of Surgery, National Hospital Abuja, Abuja, Nigeria
| | - Y B Adamu
- Department of Surgery, National Hospital Abuja, Abuja, Nigeria
| | - D K Apollo
- Department of Surgery, National Hospital Abuja, Abuja, Nigeria
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Jivani HB, Joshi P, Dsouza J. Beyond the Surface: Exploring Chest Trauma With Conventional Radiography and CT. Cureus 2023; 15:e41750. [PMID: 37575706 PMCID: PMC10415853 DOI: 10.7759/cureus.41750] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Traumatic injuries to the chest are a frequent cause of mortality among young individuals. Imaging plays a crucial role in the management of thoracic trauma, providing essential details for accurate diagnosis and treatment. OBJECTIVE To assess the respective contributions of radiography and CT in cases of chest trauma. SETTINGS AND DESIGN We assessed 64 subjects, gathering findings from both CT scans and radiographic imaging. The results were organized into a table, considering various variables such as subcutaneous emphysema, rib fractures, clavicular fractures, sternal fractures, scapular fractures, vertebral fractures, pneumothorax, pneumomediastinum, hemothorax, lung contusions, diaphragmatic injuries, and lung herniations. We analyzed the incidence and mode of injury for each variable. Additionally, we compared the sensitivity and specificity of radiographs to CT scans. RESULTS The leading cause of chest trauma was road traffic accidents (RTAs) (67.2%). The most common age groups affected were 18-30 years (31.3%) and 30-40 years (25%). Rib fractures (73.4%), contusions (70.3%), and hemothorax (62.5%) were the most frequently observed findings. Comparing the detection rates of contusions, rib fractures, hemothorax/pleural effusions, pneumothorax/pneumomediastinum, radiographs exhibited lower sensitivity than CT scans (p-value < 0.05 for all comparisons). CONCLUSIONS In the assessment of trauma patients, chest radiographs continue to serve as the primary screening method, while CT scans are the preferred imaging technique. CT scans are preferable to radiographs in subjects who are clinically stable, providing valuable information. However, for subjects who are unstable, CT scans become even more indispensable, as they offer critical insights into their condition.
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Affiliation(s)
- Hit B Jivani
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
| | - Priscilla Joshi
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
| | - John Dsouza
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
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Kaewlai R, Chatpuwaphat J, Butnian K, Thusneyapan K, Panrong N, Lertpipopmetha W, Wongpongsalee T. Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation. TOMOGRAPHY (ANN ARBOR, MICH.) 2022; 8:2772-2783. [PMID: 36412690 PMCID: PMC9680416 DOI: 10.3390/tomography8060231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The thoracic inlet of blunt trauma patients may have pathologies that can be diagnosed on cervical spine computed tomography (CT) but that are not evident on concurrent portable chest radiography (pCXR). This retrospective investigation aimed to identify the prevalence of thoracic inlet pathologies on cervical spine CT and their importance by measuring the diagnostic performance of pCXR and the predictive factors of such abnormalities. METHODS This investigation was performed at a level-1 trauma center and included CT and concurrent pCXR of 385 consecutive adult patients (280 men, mean age of 47.6 years) who presented with suspected cervical spine injury. CT and pCXR findings were independently re-reviewed, and CT was considered the reference standard. RESULTS Traumatic, significant nontraumatic and nonsignificant pathologies were present at 23.4%, 23.6% and 58.2%, respectively. The most common traumatic diagnoses were pneumothorax (12.7%) and pulmonary contusion (10.4%). The most common significant nontraumatic findings were pulmonary nodules (8.1%), micronodules (6.8%) and septal thickening (4.2%). The prevalence of active tuberculosis was 3.4%. The sensitivity and positive predictive value of pCXR was 56.67% and 49.51% in diagnosing traumatic and 8.89% and 50% in significant nontraumatic pathologies. No demographic or pre-admission clinical factors could predict these abnormalities. CONCLUSIONS Several significant pathologies of the thoracic inlet were visualized on trauma cervical spine CT. Since a concurrent pCXR was not sensitive and no demographic or clinical factors could predict these abnormalities, a liberal use of chest CT is suggested, particularly among those experiencing high-energy trauma with significant injuries of the thoracic inlet. If chest CT is not available, a meticulous evaluation of the thoracic inlet in the cervical spine CT of blunt trauma patients is important.
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Affiliation(s)
- Rathachai Kaewlai
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Jitti Chatpuwaphat
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Krittachat Butnian
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Kittipott Thusneyapan
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Nutthanun Panrong
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Wanicha Lertpipopmetha
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Thongsak Wongpongsalee
- Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
- Correspondence: ; Tel.: +66-86-015-5915
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12
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Chest Tube Placement in Mechanically Ventilated Trauma Patients: Differences between Computed Tomography-Based Indication and Clinical Decision. J Clin Med 2022; 11:jcm11144043. [PMID: 35887807 PMCID: PMC9324502 DOI: 10.3390/jcm11144043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
The rate of occult pneumothorax in intubated and mechanically ventilated trauma patients until initial computed tomography (CT) remains undetermined. The primary aims of this study were to analyze initial chest CTs with respect to the thoracic pathology of trauma, the clinical injury severity, and chest tube placement (CTP) before and after CT. In a single-center retrospective analysis of 616 intubated and mechanically ventilated adult patients admitted directly from the scene to the emergency department (ED), 224 underwent CTP (36%). Of these, 142 patients (62%) underwent CTP before CT, of which, 125 (88%) had significant chest injury on CT. Seventeen patients had minor or absent chest injuries, most of which were associated with transient or unrecognized tracheal tube malposition. After CT, CTP was performed in another 82 patients, of which, 56 (68.3%) had relevant pneumothorax and 26 had minor findings on CT. Sixty patients who had already undergone CTP before CT received another CTP after CT, of which, 15 (25%) had relevant pneumothorax and 45 (75%) had functionality issues or malposition requiring replacement. Nine patients showed small pneumothorax on CT, and did not undergo CTP (including four patients with CTP before CT). The physiological variables were unspecific, and the trauma scores were dependent on the CT findings for identifying patients at risk for CTP. In conclusion, the clinical decisions for CTP before CT are associated with relevant false-negative and false-positive cases. Clinical assessment and CT imaging, together, are important indicators for CTP decisions that cannot be achieved by using clinical assessment or CT alone.
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13
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Reindl S, Jawny P, Girdauskas E, Raab S. Is it Necessary to Stabilize Every Fracture in Patients with Serial Rib Fractures in Blunt Force Trauma? Front Surg 2022; 9:845494. [PMID: 35756475 PMCID: PMC9218347 DOI: 10.3389/fsurg.2022.845494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Management of traumatic rib fractures is subject of controversial discussions. Rib fractures are common, especially after traffic accidents and falls. There is no consensus on whether and how many rib fractures need reconstruction. Not every rib fracture needs to be stabilized, but conservative treatment by internal splinting and analgesia is not effective for all patients. Deformities of the chest wall with reduced thoracic volume and restrictive ventilation disorders must be avoided. Intraoperative assessment of fractures and chest stability plays a central role. Material and methods From 07/2016 to 07/2021, a total of 121 chest wall stabilizations were performed (m:f = 2:1, age 65 ± 14.5 a). Indications for surgery were the following criteria: (1) palpatory instability of the chest wall, (2) dislocated fracture endings, (3) concomitant injuries, (4) uncontrollable pain symptoms. In all patients, a computed tomography scan of the thorax was performed before the osteosynthetic treatment to assess dislocation of the fracture endings and possible concomitant injuries of intrathoracic organs. Results Video-assisted thoracoscopy was performed in all patients. Hemothorax and concomitant injuries of the lung, diaphragm and mediastinum could be assessed. This was followed by an intraoperative assessment of the rib fractures, in particular penetration of fracture endings and resulting instability and deformity. Relevant fractures could be identified and subsequent incisions for rib osteosynthesis precisely defined. 6.3 (±2.7) rib fractures were detected, but 2.4 (±1.2) ribs treated osteosynthetically. Bilateral rib fractures were present in 26 patients (21.5%). Post-operative bleeding occurred in seven patients (5.8%), a breakage of the osteosynthetic material in two patients (1.7%). Discussion Intraoperative assessment of relevant fractures and dislocation is the decisive criterium for osteosynthesis. Thoracoscopy is mandatory for this purpose - also to identify accompanying injuries. Not every fracture has to be approached osteosynthetically. Even with serial rib fractures or multiple fractures in a single rib, the thoracic contour can be restored by stabilizing only relevant fractures. Intraoperative palpation can adequately assess the stability and thus the result of the osteosynthesis. Even after surgical treatment of thoracic trauma, adequate analgesia and respiratory therapy are important to the healing process.
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Affiliation(s)
- Sebastian Reindl
- Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany
| | - Philipp Jawny
- Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany
| | - Evaldas Girdauskas
- Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany
| | - Stephan Raab
- Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany
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14
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Flaaten N, Dyke G. First rib fracture: Still a marker of trauma severity? Emerg Med Australas 2022; 34:808-811. [PMID: 35445531 DOI: 10.1111/1742-6723.13983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE First rib fractures (FRFs) have historically been a marker for severe trauma and poor outcomes. The aim of the present study was to assess whether an association still exists between a fractured first rib and global trauma scores suffered by the patient, examine mortality rates and identify other commonly associated injuries. METHODS This retrospective study examined records collected from patients from the Rockhampton Hospital with a traumatic FRF from July 2015 to June 2020. Patient demographics, mortality rate and injuries sustained were compiled. The Injury Severity Score (ISS) was utilised and calculated for each patient. Analysis was conducted to determine associations between trauma scores and FRFs. RESULTS In total, 545 patients had a rib fracture with 48 patients identified as having an FRF. Median age was 50 years. Thirty-seven (77%) were male. The most common mechanism of FRF was motor vehicle/motorbike accidents (71%). Fifty percent of patients with an observed FRF had the highest global ISS of very severe, with 13% severe, 22% moderate and 15% mild. No patients died from their injuries. Of those with an FRF, 79% experienced fractures other than ribs, 75% had other rib fractures and 52% had chest injuries. CONCLUSIONS A larger than expected proportion of FRFs were not associated with severe trauma scores or high mortality. These findings suggest that patients with an FRF may have a greater chance of surviving their traumatic FRF than previously reported. Clinicians should be aware of the potential for severity and specific associated injuries when treating a patient with FRFs.
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Affiliation(s)
- Nordan Flaaten
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Garry Dyke
- Department of Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
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15
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Hinsen M, Heiss R, Nagel AM, Lévy S, Uder M, Bickelhaupt S, May MS. [Imaging of the lung using low-field magnetic resonance imaging]. Radiologe 2022; 62:418-428. [PMID: 35416476 PMCID: PMC9006515 DOI: 10.1007/s00117-022-00996-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
Hintergrund Die Untersuchung der Lunge mit der Magnetresonanztomographie (MRT) geht mit hohen Herausforderungen einher und konnte sich im klinischen Alltag bisher nicht durchsetzen. Aktuelle Entwicklungen der Niederfeld-MRT, in Kombination mit neuen computergestützten Aufnahme- und Auswertungsalgorithmen, versprechen neue Perspektiven für die bildgebende Diagnostik pulmonaler Erkrankungen. Ziel dieser Arbeit Diese Übersichtsarbeit soll ein Verständnis der physikalischen Vorteile der Niederfeld-MRT für die Lungenbildgebung vermitteln, einen Überblick über die spärlich vorhandenen Vorkenntnisse aus der Literatur bieten und erste Ergebnisse eines neu entwickelten Niederfeld-MRT präsentieren. Methoden Inhalte dieses Artikels basieren auf physikalischen Grundlagen, Recherchen in Literaturdatenbanken und eigenen Erfahrungen in der Lungenbildgebung mit einem modernen 0,55-T-MRT. Schlussfolgerung Die Niederfeld-MRT (< 1 T) kann technische und ökonomische Vorteile gegenüber höheren Feldstärken für die Lungenbildgebung haben. Die physikalischen Voraussetzungen sind aufgrund geringerer Suszeptibilitätseffekte, längerer transversaler Relaxationszeiten und niedrigerer spezifischer Absorptionsraten besonders für die Anatomie der Lunge vorteilhaft. Die geringeren Anschaffungs- und Betriebskosten haben zudem ein großes Potenzial, die Verfügbarkeit zu erhöhen und gleichzeitig die Nachhaltigkeit zu verbessern. Durch die Kombination moderner Sequenzen und computergestützter Auswertungen kann die morphologische Bildgebung um orts- und zeitaufgelöste funktionelle Untersuchungen der Lunge ohne Strahlenbelastung ergänzt werden. Sowohl für kritische Szenarien, wie Screening und engmaschiges Therapiemonitoring, als auch für besonders gefährdete Patientengruppen könnten Lücken geschlossen werden. Dazu gehören beispielsweise akute und chronische Lungenerkrankungen bei Kindern oder die Abklärung einer Lungenembolie bei Schwangeren.
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Affiliation(s)
- Maximilian Hinsen
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Armin M Nagel
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland
| | - Simon Lévy
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Sebastian Bickelhaupt
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Matthias S May
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland. .,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland.
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16
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Yao L, Guan X, Song X, Tan Y, Wang C, Jin C, Chen M, Wang H, Zhang M. Rib fracture detection system based on deep learning. Sci Rep 2021; 11:23513. [PMID: 34873241 PMCID: PMC8648839 DOI: 10.1038/s41598-021-03002-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023] Open
Abstract
Rib fracture detection is time-consuming and demanding work for radiologists. This study aimed to introduce a novel rib fracture detection system based on deep learning which can help radiologists to diagnose rib fractures in chest computer tomography (CT) images conveniently and accurately. A total of 1707 patients were included in this study from a single center. We developed a novel rib fracture detection system on chest CT using a three-step algorithm. According to the examination time, 1507, 100 and 100 patients were allocated to the training set, the validation set and the testing set, respectively. Free Response ROC analysis was performed to evaluate the sensitivity and false positivity of the deep learning algorithm. Precision, recall, F1-score, negative predictive value (NPV) and detection and diagnosis were selected as evaluation metrics to compare the diagnostic efficiency of this system with radiologists. The radiologist-only study was used as a benchmark and the radiologist-model collaboration study was evaluated to assess the model's clinical applicability. A total of 50,170,399 blocks (fracture blocks, 91,574; normal blocks, 50,078,825) were labelled for training. The F1-score of the Rib Fracture Detection System was 0.890 and the precision, recall and NPV values were 0.869, 0.913 and 0.969, respectively. By interacting with this detection system, the F1-score of the junior and the experienced radiologists had improved from 0.796 to 0.925 and 0.889 to 0.970, respectively; the recall scores had increased from 0.693 to 0.920 and 0.853 to 0.972, respectively. On average, the diagnosis time of radiologist assisted with this detection system was reduced by 65.3 s. The constructed Rib Fracture Detection System has a comparable performance with the experienced radiologist and is readily available to automatically detect rib fracture in the clinical setting with high efficacy, which could reduce diagnosis time and radiologists' workload in the clinical practice.
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Affiliation(s)
- Liding Yao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Xiaowei Song
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Yanbin Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Chun Wang
- Hithink RoyalFlush Information Network Co., Ltd, No. 18 Tongshun Street, Yuhang District, Hangzhou, 310012, Zhejiang, China
| | - Chaohui Jin
- Hithink RoyalFlush Information Network Co., Ltd, No. 18 Tongshun Street, Yuhang District, Hangzhou, 310012, Zhejiang, China
| | - Ming Chen
- Hithink RoyalFlush Information Network Co., Ltd, No. 18 Tongshun Street, Yuhang District, Hangzhou, 310012, Zhejiang, China
| | - Huogen Wang
- Hithink RoyalFlush Information Network Co., Ltd, No. 18 Tongshun Street, Yuhang District, Hangzhou, 310012, Zhejiang, China.
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
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17
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Liu X, Wu D, Xie H, Xu Y, Liu L, Tao X, Wang X. Clinical evaluation of AI software for rib fracture detection and its impact on junior radiologist performance. Acta Radiol 2021; 63:1535-1545. [PMID: 34617809 DOI: 10.1177/02841851211043839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The detection of rib fractures (RFs) on computed tomography (CT) images is time-consuming and susceptible to missed diagnosis. An automated artificial intelligence (AI) detection system may be helpful to improve the diagnostic efficiency for junior radiologists. PURPOSE To compare the diagnostic performance of junior radiologists with and without AI software for RF detection on chest CT images. MATERIALS AND METHODS Six junior radiologists from three institutions interpreted 393 CT images of patients with acute chest trauma, with and without AI software. The CT images were randomly split into two sets at each institution, with each set assigned to a different radiologist First, the detection of all fractures (AFs), including displaced fractures (DFs), non-displaced fractures and buckle fractures, was analyzed. Next, the DFs were selected for analysis. The sensitivity and specificity of the radiologist-only and radiologist-AI groups at the patient level were set as primary endpoints, and secondary endpoints were at the rib and lesion level. RESULTS Regarding AFs, the sensitivity difference between the radiologist-AI group and the radiologist-only group were significant at different levels (patient-level: 26.20%; rib-level: 22.18%; lesion-level: 23.74%; P < 0.001). Regarding DFs, the sensitivity difference was 16.67%, 14.19%, and 16.16% at the patient, rib, and lesion levels, respectively (P < 0.001). No significant difference was found in the specificity between the two groups for AFs and DFs at the patient and rib levels (P > 0.05). CONCLUSION AI software improved the sensitivity of RF detection on CT images for junior radiologists and reduced the reading time by approximately 1 min per patient without decreasing the specificity.
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Affiliation(s)
- Xiang Liu
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Dijia Wu
- Shanghai United Imaging Intelligence Co., Ltd, Shanghai, PR China
| | - Huihui Xie
- Department of Radiology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Yufeng Xu
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Lin Liu
- Department of Radiology, 74569China-Japan Union Hospital of Jilin University, Changchun, PR China
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Xiaoying Wang
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
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18
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Umasanker S, Khera D, Didel S, Yadav T. Postcardiopulmonary Resuscitation Unilateral Flail Chest Unmasked by Dystonia. Indian J Pediatr 2021; 88:833. [PMID: 34037937 DOI: 10.1007/s12098-021-03802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Swati Umasanker
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. .,Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342001, India.
| | - Siyaram Didel
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342001, India
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19
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Yoon SM, Suh R, Abtin F, Moghanaki D, Genshaft S, Kamrava M, Drakaki A, Liu S, Venkat P, Lee A, Chang AJ. Outcomes with multi-disciplinary management of central lung tumors with CT-guided percutaneous high dose rate brachyablation. Radiat Oncol 2021; 16:99. [PMID: 34098977 PMCID: PMC8186067 DOI: 10.1186/s13014-021-01826-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Centrally located lung tumors present treatment challenges given their proximity to mediastinal structures including the central airway, esophagus, major vessels, and heart. Therapeutic options can be limited for medically inoperable patients, particularly if they have received previous thoracic radiotherapy. High dose rate (HDR) brachyablation was developed to improve the therapeutic ratio for patients with central lung tumors. The purpose of this study is to report initial safety and efficacy outcomes with this treatment for central lung malignancies. METHODS From September 2015 to August 2019, a total of 25 patients with 37 pulmonary tumors were treated with percutaneous HDR brachyablation. Treatment was delivered by a multi-disciplinary team of interventional radiologists, pulmonologists, and radiation oncologists. Twenty-three patients received a median dose of 21.5 Gy (range 15-27.5) in a single fraction, whereas two patients received median dose of 24.75 Gy (range 24-25.5) over 2-3 fractions. Tumor local control (LC) was evaluated by Response Evaluation Criteria in Solid Tumors v1.1. Treatment-related toxicities were graded by Common Terminology Criteria for Adverse Events v5.0, with adverse events less than 90 days defined as acute, and those occurring later were defined as late. LC, progression-free survival (PFS), and overall survival (OS) rates were estimated by the Kaplan-Meier method. RESULTS Of 37 treated tumors, 88% were metastatic. Tumor location was central and ultra-central in 24.3% and 54.1%, respectively. Average tumor volume was 11.6 cm3 (SD 12.4, range 0.57-62.8). Median follow-up was 19 months (range 3-48). Two-year LC, PFS, and OS were 96.2%, 29.7%, and 65.5%, respectively. Thirteen of 39 (33.3%) catheter implantation procedures were associated with trace minor pneumothorax requiring no intervention, 1 (2.5%) procedure with minor radiographic pulmonary hemorrhage, and 4 (10.3%) with major pneumothorax requiring chest tube insertions. All procedural complications resolved within 24 h from treatment. Acute grade 1-2 toxicity was identified in 4 patients, whereas none developed late toxicity beyond 90 days of follow-up. CONCLUSION Percutaneous HDR brachyablation is a safe and promising treatment option for centrally located primary and metastatic lung tumors. Future comparisons with stereotactic body radiotherapy and other ablative techniques are warranted to expand multi-disciplinary management options.
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Affiliation(s)
- Stephanie M Yoon
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA
| | - Robert Suh
- Department of Radiology Thoracic Interventional Services, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Fereidoun Abtin
- Department of Radiology Thoracic Interventional Services, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Drew Moghanaki
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA.,Department of Radiation Oncology, Veterans Affairs Greater Los Angeles, Los Angeles, CA, 90073, USA
| | - Scott Genshaft
- Department of Radiology Thoracic Interventional Services, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Alexandra Drakaki
- Department of Hematology and Medical Oncology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Sandy Liu
- Department of Hematology and Medical Oncology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA
| | - Alan Lee
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA
| | - Albert J Chang
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA.
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20
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Ugalde IT, Prater S, Cardenas-Turanzas M, Sanghani N, Mendez D, Peacock J, Guvernator G, Koerner C, Allukian M. Chest x-ray vs. computed tomography of the chest in pediatric blunt trauma. J Pediatr Surg 2021; 56:1039-1046. [PMID: 33051082 DOI: 10.1016/j.jpedsurg.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Chest x-ray (CXR) has been shown to be an effective detection tool for clinically significant trauma. We evaluated differences in findings between CXR and computed tomography of the chest (CCT), their impact on clinical management and the performance of the CXR. METHODS This retrospective study examined children (less than 18 years) who received a CXR and CCT between 2009 and 2015. We compared characteristics of children by conducting univariate analysis, reporting the proportion of additional diagnoses captured by CCT, and using it to evaluate the sensitivity and specificity of the CXR. Outcome variables were diagnoses made by CCT as well as the ensuing changes in the clinical management attributable to the diagnoses reported by the CCT and not observed by the CXR. RESULTS In 1235 children, CCT was associated with diagnosing higher proportions of contusion or atelectasis (60% vs 31%; p < .0001), pneumothorax (23% vs 9%; p < .0001), rib fracture (18% vs 7%; p < .0001), other fracture (20% vs 10%; p < .0001), diaphragm rupture (0.2% vs 0.1%; p = .002), and incidental findings (7% vs 2%; p < .0001) as compared to CXR. CCT findings changed the management of 107 children (8.7%) with 32 (2.6%) of the changes being surgical procedures. The overall sensitivity and specificity of the CXR were 57.9% (95% CI: 54.5-61.2) and 90.2% (95% CI: 86.8-93.1), respectively. The positive predictive value and negative predictive value were 93.1% and 48.6%, respectively. CONCLUSION CXR is a useful initial screening tool to evaluate pediatric trauma patients along with clinical presentation in the Emergency Department in children. LEVEL OF EVIDENCE Level III, diagnostic test.
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Affiliation(s)
- Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School at UT Health Sciences Center, Houston, TX.
| | - Samuel Prater
- Department of Emergency Medicine, McGovern Medical School at UT Health Sciences Center, Houston, TX
| | - Marylou Cardenas-Turanzas
- School of Biomedical Informatics and McGovern Medical School at UT Health Sciences Center, Houston, TX
| | - Nipa Sanghani
- Department of Emergency Medicine, McGovern Medical School at UT Health Sciences Center, Houston, TX
| | - Donna Mendez
- Department of Emergency Medicine, McGovern Medical School at UT Health Sciences Center, Houston, TX
| | - John Peacock
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Grace Guvernator
- Department of Anesthesiology, McGovern Medical School at UT Health Sciences Center, Houston, TX
| | - Christine Koerner
- Department of Emergency Medicine, McGovern Medical School at UT Health Sciences Center, Houston, TX
| | - Myron Allukian
- Division of Pediatric, General, Thoracic, and Fetal Surgery and the Trauma Center at the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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21
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Imaging Modalities in Trauma and Emergency—a Review. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Stojanovska J, Hurwitz Koweek LM, Chung JH, Ghoshhajra BB, Walker CM, Beache GM, Berry MF, Colletti PM, Davis AM, Hsu JY, Khosa F, Kicska GA, Kligerman SJ, Litmanovich D, Maroules CD, Meyersohn N, Syed MA, Tong BC, Villines TC, Wann S, Wolf SJ, Kanne JP, Abbara S. ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury. J Am Coll Radiol 2020; 17:S380-S390. [PMID: 33153551 DOI: 10.1016/j.jacr.2020.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
Blunt cardiac injuries range from myocardial concussion (commotio cordis) leading to fatal ventricular arrhythmias to myocardial contusion, cardiac chamber rupture, septal rupture, pericardial rupture, and valvular injuries. Blunt injuries account for one-fourth of the traumatic deaths in the United States. Chest radiography, transthoracic echocardiography, CT chest with and without contrast, and CT angiography are usually appropriate as the initial examination in patients with suspected blunt cardiac injury who are both hemodynamically stable and unstable. Transesophageal echocardiography and CT heart may be appropriate as examination in patients with suspected blunt cardiac injuries. This publication of blunt chest trauma-suspected cardiac injuries summarizes the literature and makes recommendations for imaging based on the available data and expert opinion. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | | | | | - Garth M Beache
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | | | - Andrew M Davis
- The University of Chicago Medical Center, Chicago, Illinois; American College of Physicians
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Mushabbar A Syed
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois; Society for Cardiovascular Magnetic Resonance
| | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Wisconsin Heart Hospital, Milwaukee, Wisconsin; Nuclear cardiology expert
| | - Stephen J Wolf
- Denver Health MC/UPI, Denver, Colorado; American College of Emergency Physicians
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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23
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Respiratory Emergencies. Vet Clin North Am Small Anim Pract 2020; 50:1237-1259. [PMID: 32891440 DOI: 10.1016/j.cvsm.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Respiratory distress is commonly seen in dogs and cats presenting to the emergency room. Rapid identification of respiratory difficulty with strategic stabilization and diagnostic efforts are warranted to maximize patient outcome. This article focuses on the relevant anatomy and physiology of the respiratory system and the clinical recognition, stabilization, and initial diagnostic planning for small animal patients that present for respiratory emergencies.
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Pines G, Gotler Y, Lazar LO, Lin G. Clinical significance of rib fractures' anatomical patterns. Injury 2020; 51:1812-1816. [PMID: 32482430 DOI: 10.1016/j.injury.2020.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Rib fractures are common and carry significant morbidity. Chest CT provides an accurate mapping of the fractures. The aim of this study is to propose an anatomical classification of rib fractures, and assess their relation to complication development. METHOD The records of all blunt trauma patients between January 1st 2014 and December 31st 2017 at a university hospital were retrospectively reviewed. Wounded who were hospitalized with rib fractures (two and more) as the primary injury were included in the study. Based on the chest CT scans, the cohort was divided into five groups: upper ribs (1-4) fractures, anterior, lateral and posterior middle ribs (4-7) fractures, and lower ribs (9-12) fractures. Data regarding demographics, complications (pneumothorax, hemothorax, chest drains, pulmonary contusion atelectasis, pneumonia, respiratory failure and death), intensive care admission and hospital stay were collected. RESULTS A total of 102 wounded were included in the study, with a mean age of 46.3 years. The mean number of fractured ribs per person was 3.82±1.68, and 46 wounded had displaced fractures. Rib fracture distribution was: upper ribs - 13.7%, anterior middle ribs - 28.5%, lateral middle ribs fractures - 27.5%, posterior middle ribs - 14.7%, lower ribs fractures - 15.7%. Wounded sustaining lateral middle ribs fractures had the highest complications rates in relation to any other fracture location group, with 25% respiratory failure rate. CONCLUSIONS Lateral middle ribs fractures are associated with a higher complication rate and may require closer oabservation.
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Affiliation(s)
- Guy Pines
- Department of Thoracic Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel; Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel.
| | - Yakov Gotler
- Department of Radiology, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel
| | - Li Or Lazar
- Department of Thoracic Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel; Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel
| | - Guy Lin
- Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel.
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25
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Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol 2020; 23:125-138. [PMID: 32417043 PMCID: PMC7296362 DOI: 10.1016/j.cjtee.2020.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/15/2020] [Accepted: 04/08/2020] [Indexed: 02/04/2023] Open
Abstract
Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.
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26
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Shyu JY, Khurana B, Soto JA, Biffl WL, Camacho MA, Diercks DB, Glanc P, Kalva SP, Khosa F, Meyer BJ, Ptak T, Raja AS, Salim A, West OC, Lockhart ME. ACR Appropriateness Criteria® Major Blunt Trauma. J Am Coll Radiol 2020; 17:S160-S174. [PMID: 32370960 DOI: 10.1016/j.jacr.2020.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 11/20/2022]
Abstract
This review assesses the appropriateness of various imaging studies for adult major blunt trauma or polytrauma in the acute setting. Trauma is the leading cause of mortality for people in the United States <45 years of age, and the fourth leading cause of death overall. Imaging, in particular CT, plays a critical role in the management of these patients, and a number of indications are discussed in this publication, including patients who are hemodynamically stable or unstable; patients with additional injuries to the face, extremities, chest, bowel, or urinary system; and pregnant patients. Excluded from consideration in this review are penetrating traumatic injuries, burns, and injuries to pediatric patients. Patients with suspected injury to the head and spine are also discussed more specifically in other appropriateness criteria documents. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Jeffrey Y Shyu
- Research Author, Brigham & Women's Hospital, Boston, Massachusetts
| | - Bharti Khurana
- Principal Author, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Jorge A Soto
- Research Author, Boston University School of Medicine, Boston, Massachusetts
| | - Walter L Biffl
- Scripps Memorial Hospital La Jolla, La Jolla, California; American Association for the Surgery of Trauma
| | - Marc A Camacho
- The University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Deborah B Diercks
- University of Texas Southwestern Medical Center, Dallas, Texas; American College of Emergency Physicians
| | - Phyllis Glanc
- University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Thomas Ptak
- University of Maryland Medical Center, Baltimore, Maryland
| | - Ali S Raja
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Society for Academic Emergency Medicine
| | - Ali Salim
- Brigham & Women's Hospital, Boston, Massachusetts; American College of Surgeons
| | - O Clark West
- UTHealth McGovern Medical School, Houston, Texas
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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Clinical predictors of abnormal chest CT scan findings following blunt chest trauma: A cross-sectional study. Chin J Traumatol 2020; 23:51-55. [PMID: 31685355 PMCID: PMC7049617 DOI: 10.1016/j.cjtee.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Some surgeons believe that chest computed tomography (CT) scan should be used more prudently in management of blunt chest trauma patients. This study aimed to evaluate the clinical predictors of abnormal chest CT scan findings in trauma patients. METHODS This cross-sectional study was conducted on blunt chest trauma patients aged ≥18 years who were referred to the emergency departments of two educational hospitals and underwent chest CT scan. These patients were enrolled in the study using a non-probability sampling method. The exclusion criteria included: class III or IV hemodynamic shock, need for immediate surgical or neurosurgical interventions, penetrating trauma, lack of required information, and pregnancy. Demographic factors, accident details, trauma mechanism, vital signs, and level of consciousness in predicting abnormal chest CT scan findings were evaluated. Analysis was performed using IBM SPSS statistics 21. RESULTS A total of 977 patients (male 51.5%, female 48.5%) with the mean age of (41.71 ± 14.24) years, range 18-88 years were studied; 34.2% of them with high energy trauma mechanism. With 334 (34.2%) patients had abnormal findings on chest X-ray (CXR) and 332 (34.0%) cases had an abnormal findings on chest CT scan (agreement rate was 99.4%). There was a significant correlation between male gender (p < 0.0001), GCS<15 (p < 0.0001), high energy trauma mechanism (p < 0.0001), unstable hemodynamics (p < 0.01), and clinical signs and symptoms (p < 0.0001) with chest CT findings. Chest wall deformity (odds = 8; p < 0.0001), generalized tenderness (odds = 6.6, p < 0.0001), and decreased cardiac sound (odds = 3.8, p < 0.0001) were the important and independent clinical predictors of abnormal chest CT scan findings. CONCLUSION Based on the findings, chest wall deformity, generalized tenderness, decreased cardiac sound, distracting pain, chest wall tenderness, high energy trauma mechanism, male gender, respiratory rate > 20 breathes/min, decreased pulmonary sound, and chest wall crepitation were independent clinical predictors of abnormal chest CT scan findings following blunt trauma.
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Carlino MV, Guarino M, Izzo A, Carbone D, Arnone MI, Mancusi C, Sforza A. Arterial blood gas analysis utility in predicting lung injury in blunt chest trauma. Respir Physiol Neurobiol 2019; 274:103363. [PMID: 31866500 DOI: 10.1016/j.resp.2019.103363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/15/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND thoracic trauma is one of the leading causes of death in all age groups and accounts for 25-50 % of all traumatic injuries. With the term lung injury in blunt chest trauma, we identified a spectrum of conditions: lung contusion, pneumothorax and haemothorax. The aim of this study was to evaluate the utility of arterial blood gas analysis parameters in predicting lung injury in blunt chest trauma. METHODS we included 51 patients presenting to the Emergency Department of "C.T.O." Hospital in Naples [Italy] for blunt chest trauma. The patients were assigned to the Lung Injury Group or to the Non-Lung Injury Group basing on CT scan findings. For each patient, we calculated the alveolar-arterial oxygen gradient [AaDO2], the AaDO2 augmentation, the arterial partial pressure of oxygen deficit [PaO2 Deficit] and the ratio between arterial partial pressure of oxygen and fraction of inspired oxygen [P/F]. Areas under the curve [AUC] and receiver operating characteristic [ROC] curve were used to compare the performance of each different test in relation to the detection of lung injury in blunt chest trauma. RESULTS patients with lung injury had lower oxygen saturation, arterial partial pressure of oxygen, P/F and higher PaO2 Deficit, AaDO2, AaDO2 augmentation than patients without lung injury. PaO2 Deficit, AaDO2 and AaDO2 augmentation showed a good accuracy to predict lung injury in blunt chest trauma. CONCLUSION our study demonstrates that the combination of different arterial blood gas analysis variables may be a fast approach for identifying patients with lung injury in the setting of blunt chest trauma in the Emergency Department.
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Affiliation(s)
| | - Mario Guarino
- Emergency Department, C. T. O. Hospital, Naples, Italy
| | - Arturo Izzo
- Emergency Department, C. T. O. Hospital, Naples, Italy
| | | | - Maria Immacolata Arnone
- Emergency Department, C. T. O. Hospital, Naples, Italy; Federico II University Hospital, Naples, Italy
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Mauf S, Held U, Gascho D, Baumeister R, Flach P, Nguyen-Kim TDL, Thali MJ, Jentzsch T. Flat chest projection in the detection and visualization of rib fractures: A cross-sectional study comparing curved and multiplanar reformation of computed tomography images in different reader groups. Forensic Sci Int 2019; 303:109942. [DOI: 10.1016/j.forsciint.2019.109942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 11/28/2022]
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30
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Dancer SC, Le Roux C, Fosgate GT, Kirberger RM. Radiography is less sensitive relative to CT for detecting thoracic radiographic changes in dogs affected by blunt trauma secondary to a motor vehicle accident. Vet Radiol Ultrasound 2019; 60:648-658. [PMID: 31353781 DOI: 10.1111/vru.12795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022] Open
Abstract
Thoracic injuries caused by blunt trauma are commonly encountered emergencies in veterinary medicine. However, published studies are lacking that compare radiology to CT in blunt trauma caused by motor vehicle accidents in canine patients. The aim of this prospective diagnostic accuracy, methods comparison study were to estimate the sensitivity (Se) and specificity (Sp) of thoracic radiology relative to CT for detecting lung contusions, pneumothorax, pleural effusion, and rib fractures. The study further aimed to develop a severity scoring system for radiology and CT and to compare the findings between the two modalities. The hypothesis was that radiology would be less sensitive than CT at detecting these injuries and that radiology would underestimate the severity of lung contusions. Fifty-nine patients met the inclusion criteria. Radiology underestimated the presence of lung contusions (Se = 69%, 95% confidence interval) and overestimated the severity of the contusions relative to CT. There was high interobserver variability in evaluating lung contusion severity (coefficient of variation = 91%). Both the three-view thoracic and horizontal beam radiography had poor sensitivities for the detecting pneumothorax (Se = 19% and 63%, respectively) and pleural effusions (Se = 43% and 71%, respectively). Similarly, the sensitivity (56%) of radiographs for the detection of rib fractures was poor relative to CT. Findings from the current study indicated that thoracic radiography had low sensitivity for detecting lesions related to blunt thoracic trauma caused by motor vehicle accidents and supported the use of CT as an additional diagnostic imaging modality in these patients.
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Affiliation(s)
- Sumari C Dancer
- Departments of Companion Animal Clinical Studies and University of Pretoria, Onderstepoort, South Africa
| | - Christelle Le Roux
- Departments of Companion Animal Clinical Studies and University of Pretoria, Onderstepoort, South Africa
| | - Geoffrey T Fosgate
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Robert M Kirberger
- Departments of Companion Animal Clinical Studies and University of Pretoria, Onderstepoort, South Africa
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31
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Chest computed tomography imaging utility for radiographically occult rib fractures in elderly fall-injured patients. J Trauma Acute Care Surg 2019; 86:838-843. [DOI: 10.1097/ta.0000000000002208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Awais M, Salam B, Nadeem N, Rehman A, Baloch NU. Diagnostic Accuracy of Computed Tomography Scout Film and Chest X-ray for Detection of Rib Fractures in Patients with Chest Trauma: A Cross-sectional Study. Cureus 2019; 11:e3875. [PMID: 30899626 PMCID: PMC6420333 DOI: 10.7759/cureus.3875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Rib fractures are a major source of morbidity in patients with chest trauma. Computed tomography (CT) scout film is a low-dose image that is obtained prior to a complete chest CT study for all patients undergoing a CT scan. In this study, we evaluated the diagnostic performance of CT scout film vis-à-vis that of chest X-ray for detection of rib fractures using chest CT scan as the reference standard. METHODS A cross-sectional study was performed at the radiology department of Aga Khan University Hospital (Karachi, Pakistan) from October 1, 2013 to September 31, 2014. Patients who underwent CT chest for evaluation of thoracic trauma were included in the study. Sensitivity and specificity of chest X-ray and CT scout film were calculated. RESULTS A total of 207 patients were included in the study (193 were male). Penetrating and blunt thoracic injuries affected 104 (50.2%) and 103 (49.8%) patients respectively. On CT chest, 75 (36.2%) patients had evidence of rib fractures. Sensitivity and specificity of CT scout film for detection of rib fractures were 56% and 87.9%, while those of chest X-ray were 61.3% and 98.5% respectively. The overall accuracy of CT scout film and chest X-ray for detection of rib fractures were 76.3% and 85% respectively. CONCLUSION Diagnostic performance of CT scout film for detection of rib fractures was comparable to that of the plain chest radiograph. CT scout film does not provide any additional information or advantage over a plain chest radiograph. In patients with severe thoracic trauma, CT chest remains the modality of choice for accurate delineation of rib fractures and associated internal injuries.
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Affiliation(s)
| | - Basit Salam
- Radiology, The Aga Khan University, Karachi, PAK
| | - Naila Nadeem
- Radiology, The Aga Khan University, Karachi, PAK
| | - Abdul Rehman
- Internal Medicine, Rutgers New Jersey Medical School, Newark, USA
| | - Noor U Baloch
- Internal Medicine, Rutgers New Jersey Medical School, Newark, USA
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Darwish B, Mahfouz MZ, Izzat MB. Usefulness of routine computed tomography in the evaluation of penetrating war injuries to the chest. Interact Cardiovasc Thorac Surg 2018; 27:703-707. [PMID: 29722886 DOI: 10.1093/icvts/ivy152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/05/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This review was conducted to compare the contributions of chest X-ray (CXR) and computed tomography (CT) towards detecting intrathoracic damage in patients with penetrating war injuries to the chest and to determine whether identification of additional injuries by chest CT will have an impact on the choice of therapeutic interventions and clinical outcomes. METHODS We reviewed records of 449 patients (374 men, mean age 29.3 ± 14.8 years) who were admitted to our hospital with penetrating war injuries to the chest over a 7-year period. Collected data included mechanisms of injury, associated injuries, results of CXRs and chest CTs, methods of management, in-hospital stays, complications and mortalities. RESULTS Immediate screening CXRs were obtained in all patients not requiring emergent thoracotomies, of which 91.4% showed positive signs of injury. Chest CTs were performed at the discretion of the physicians in 49.4% of patients, and CXR-positive findings were confirmed in all cases, while revealing additional injuries in 11% of patients. Chest CT findings led to additional closed chest drainage in 5.6% of patients but had no impact on treatment strategy in 94.4% of scanned patients. Follow-up CXRs showed new positive findings in 22 patients, leading to additional closed chest drainage in 3 patients and delayed open thoracotomies in 7 other patients. CONCLUSIONS CXRs continue as the primary diagnostic modality in the assessment of patients with penetrating war injuries to the chest. Chest CTs can be omitted in most patients, thus reducing CT imaging case-load substantially, while most clinically significant chest injuries remain sufficiently recognized.
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Affiliation(s)
- Bassam Darwish
- Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohammad Z Mahfouz
- Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
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Guchlerner L, Wichmann JL, Tischendorf P, Albrecht M, Vogl TJ, Wutzler S, Ackermann H, Eichler K, Frellesen C. Comparison of thick- and thin-slice images in thoracoabdominal trauma CT: a retrospective analysis. Eur J Trauma Emerg Surg 2018; 46:187-195. [PMID: 30267119 DOI: 10.1007/s00068-018-1021-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare thick (5 mm) and thin slice images (1.5 mm) of lung, soft tissue, and bone window in thoracoabdominal trauma computed tomography. MATERIALS AND METHODS 167 Patients that underwent thoracoabdominal trauma CT between November 2014 and December 2015 were included in the study. CT data were reconstructed in a transverse direction with 5 mm and 1.5 mm slice images of lung, soft tissue, and bone window. Two blinded raters (radiologists) evaluated the collected data by detecting predefined injuries in different organ areas. Reconstruction and evaluation times as well as detected injuries were noted and compared. RESULTS Reconstruction and evaluation times were significantly higher with 1.5 mm thin-slice images, and the effect strength according to Rosenthal displayed a strong effect of 0.61 (< 0.1 small effect, 0.3 middle effect, and > 0.5 strong effect). Average evaluation time differences were 62.7 s (33.9 s-91.5 s) in bone window between 1.5 mm and 3 mm for rater 1 (p < 0.001) and 71.4 s (43.1 s-99.7 s) for rater 2 (p < 0.001). Average time differences between 1.5 mm and 5 mm were 68,7 s (43.9 s-93.5 s) for rater 1 and 75.3 s (44.7 s-105.9 s) for rater 2 in lung window (p < 0.001) and 66.6 s (28.8 s-104.4 s) for rater 1 and 114 s (74.4 s-153.6 s) for rater 2 in soft-tissue window (p < 0.001). There was no significant difference regarding soft-tissue and lung injuries, except non-significant improvement in the detection of bone fractures. CONCLUSION Thin-slice images do not bring any significant benefit in thoracoabdominal trauma CT of soft-tissue and lung injuries, but they can be helpful for the diagnosis of bone fractures and incidental findings.
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Affiliation(s)
- Leon Guchlerner
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Julian Lukas Wichmann
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Patricia Tischendorf
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Moritz Albrecht
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Josef Vogl
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sebastian Wutzler
- Department of Trauma, Hand and Reconstructive Surgery, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Hanns Ackermann
- Department of Biostatistics and Mathematical Modelling, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Claudia Frellesen
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Brown C, Elmobdy K, Raja AS, Rodriguez RM. Scapular Fractures in the Pan-scan Era. Acad Emerg Med 2018; 25:738-743. [PMID: 29322585 DOI: 10.1111/acem.13377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/11/2017] [Accepted: 01/06/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Scapular fractures have been traditionally taught to be associated with significant injuries and major morbidity. As we demonstrated with sternal fracture, pulmonary contusion, and rib fracture, increased chest computed tomography (CT) utilization and head-to-pelvis CT (pan-scan) protocols in blunt trauma evaluation, however, may diagnose minor, clinically irrelevant scapular fractures, possibly rendering previous teachings obsolete. OBJECTIVES The objectives were to determine the 1) percentages of scapular fractures seen on chest CT only (SOCTO) versus seen on both chest x-ray (CXR) and CT and of isolated scapular fracture (scapular fracture without other thoracic injuries); 2) frequencies of associated thoracic injury with scapular fracture; and 3) proportion of patients admitted, mortality, hospital length of stay, and injury severity scores (ISS), comparing four patient groups: scapular fracture, nonscapular fracture, scapular fracture SOCTO, and isolated scapular fracture. METHODS We conducted a preplanned analysis of patients prospectively enrolled in the NEXUS Chest CT study at nine Level I trauma centers with the following inclusion criteria: age > 14 years, blunt trauma within 6 hours of ED presentation, and receiving chest imaging during ED trauma evaluation. RESULTS Of 11,477 subjects, 4,501 (39.2%) patients who had both CXR and chest CT and 2.7% of these had scapular fractures; 60.3% of these were SOCTO and 23 (19.0%) were isolated scapular fracture. The most commonly associated thoracic injuries were rib fracture, pulmonary contusion, pneumothorax, and thoracic spine fracture and all injuries were more common in scapular fracture patients than nonscapular fracture patients. Although scapular fracture patients had higher admission rates (86.8% vs. 47.4%; difference in proportions = 39.4% [95% confidence interval {CI} = 32.8% to 44.1%]), ISS (21 vs. 5), and length of stay (9.2 days vs. 5.6 days; mean difference = 3.4 days [95% CI = 2.1 to 4.7 days]) than patients without scapular fracture, their hospital mortality was not significantly different (5.6% vs. 3.0%; difference in proportions = 2.6% [95% CI = -8.2% to 0.3%]; unadjusted odds ratio = 1.9 [95% CI = 0.9 to 4.2]). Patients with scapular fracture SOCTO and isolated scapular fracture had higher admission rates and median ISS than nonscapular fracture patients, but their mortality was similar. CONCLUSIONS Under current blunt trauma imaging protocols that commonly include chest CT, most scapular fractures are SOCTO and most are associated with other thoracic injuries. Although patients with scapular fracture SOCTO and isolated scapular fracture have higher admission rates and ISS than nonscapular fracture patients, their hospital mortality is similar.
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Affiliation(s)
- Cortlyn Brown
- Department of Emergency Medicine The University of California San Francisco San Francisco CA
| | - Karim Elmobdy
- The University of California San Francisco San Francisco CA
| | - Ali S Raja
- Department of Emergency Medicine Harvard School of Medicine Boston MA
| | - Robert M. Rodriguez
- Department of Emergency Medicine The University of California San Francisco San Francisco CA
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Bader A, Rahman U, Morris M, McCormack JE, Huang EC, Zawin M, Vosswinkel JA, Jawa RS. Pulmonary contusions in the elderly after blunt trauma: incidence and outcomes. J Surg Res 2018; 230:110-116. [PMID: 30100025 DOI: 10.1016/j.jss.2018.04.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/16/2018] [Accepted: 04/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the general population with blunt chest trauma, pulmonary contusions (PCs) are commonly identified. However, there is limited research in the elderly. We sought to evaluate the incidence and outcomes of PCs in elderly blunt trauma admissions. METHODS We retrospectively reviewed the trauma registry at a level I trauma center for all blunt thoracic trauma patients aged ≥65 y, who were admitted between 2007 and 2015. The medical records of PC patients were reviewed. RESULTS There were 956 admissions with blunt thoracic trauma; of which 778 had no pulmonary contusion (NO) and 178 had PC. The major mechanisms of injury were falls (58.7% NO, 39.3% PC, P <0.001) and motor vehicle crash/motor cycle crash (35.6% NO, 51.7% PC, P <0.001). Rib fractures were present in 79.8% of PC and 73.8% of NO patients, P = 0.1. PC patients more often had serious (AIS ≥3) head/neck (30.3% versus 20.6%, P <0.001), abdomen (12.4% versus 6.6%, P <0.001), and extremity injuries (20.8% versus 11.4%, P <0.001). Complication (46.1% PC versus 26.6% NO, P <0.001) and mortality (14.0% PC versus 6.2% NO, P = 0.0003) rates were higher in PC patients. On multivariate logistic regression analyses, PC presence was significantly associated with mechanical ventilation (odds ratio 2.5), intensive care unit admission (odds ratio 2.3), and mortality (odds ratio 1.9). CONCLUSIONS Over 18.6% of elderly blunt thoracic trauma patients sustained PC, despite an often low energy mechanism of injury. The presence of a PC should prompt investigation for other serious intrathoracic and extrathoracic injuries. PC presence is associated with substantial morbidity and mortality.
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Affiliation(s)
- Amanda Bader
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Uzma Rahman
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Matthew Morris
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Jane E McCormack
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Emily C Huang
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Marlene Zawin
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, New York
| | - James A Vosswinkel
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Randeep S Jawa
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York.
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Safari S, Radfar F, Baratloo A. Thoracic injury rule out criteria and NEXUS chest in predicting the risk of traumatic intra-thoracic injuries: A diagnostic accuracy study. Injury 2018; 49:959-962. [PMID: 29402426 DOI: 10.1016/j.injury.2018.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/06/2018] [Accepted: 01/20/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study aimed to compare the diagnostic accuracy of NEXUS chest and Thoracic Injury Rule out criteria (TIRC) models in predicting the risk of intra-thoracic injuries following blunt multiple trauma. METHODS In this diagnostic accuracy study, using the 2 mentioned models, blunt multiple trauma patients over the age of 15 years presenting to emergency department were screened regarding the presence of intra-thoracic injuries that are detectable via chest x-ray and screening performance characteristics of the models were compared. RESULTS In this study, 3118 patients with the mean (SD) age of 37.4 (16.9) years were studied (57.4% male). Based on TIRC and NEXUS chest, respectively, 1340 (43%) and 1417 (45.4%) patients were deemed in need of radiography performance. Sensitivity, specificity, and positive and negative predictive values of TIRC were 98.95%, 62.70%, 21.19% and 99.83%. These values were 98.61%, 59.94%, 19.97% and 99.76%, for NEXUS chest, respectively. Accuracy of TIRC and NEXUS chest models were 66.04 (95% CI: 64.34-67.70) and 63.50 (95% CI: 61.78-65.19), respectively. CONCLUSION TIRC and NEXUS chest models have proper and similar sensitivity in prediction of blunt traumatic intra-thoracic injuries that are detectable via chest x-ray. However, TIRC had a significantly higher specificity in this regard.
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Affiliation(s)
- Saeed Safari
- Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Radfar
- Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Baratloo
- Emergency Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Awais M, Qamar S, Rehman A, Baloch NUA, Shafqat G. Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study. Eur J Trauma Emerg Surg 2018; 45:517-525. [PMID: 29484462 DOI: 10.1007/s00068-018-0929-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/23/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Esophageal perforation has a high mortality rate. Fluoroscopic esophagography (FE) is the procedure of choice for diagnosing esophageal perforation. However, FE can be difficult to perform in seriously ill patients. METHODS We retrospectively reviewed charts and scans of all patients who had undergone thoracic CT (TCT) without oral contrast and FE for suspicion of esophageal perforation at our hospital between October, 2010 and December, 2015. Scans were interpreted by a single consultant radiologist having > 5 years of relevant experience. Statistical analysis was performed using SPSS version 20. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TCT were computed using FE as reference standard. RESULTS Of 122 subjects, 106 (83%) were male and their median age was 42 [inter-quartile range (IQR) 29-53] years. Esophageal perforation was evident on FE in 15 (8%) cases. Sensitivity, specificity, PPV and NPV of TCT for detecting esophageal perforation were 100, 54.6, 23.4 and 100%, respectively. When TCT was negative (n = 107), an alternative diagnosis was evident in 65 cases. CONCLUSION Thoracic computed tomography (TCT) had 100% sensitivity and negative predictive value for excluding esophageal perforation. FE may be omitted in patients who have no evidence of mediastinal collection, pneumomediastinum or esophageal wall defect on TCT. However, in the presence of any of these features, FE is still necessary to confirm or exclude the presence of an esophageal perforation.
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Affiliation(s)
- Muhammad Awais
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan. .,Department of Radiology, Dow University of Health Sciences, Ojha Campus, Suparco Road, KDA Scheme 33, Karachi, Sindh, 75270, Pakistan.
| | - Saqib Qamar
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan
| | - Abdul Rehman
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.,Internal Medicine Section, Department of Medicine, Hamad Medical Corporation, P.O. box 3050, Doha, Qatar
| | - Noor Ul-Ain Baloch
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.,Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Gulnaz Shafqat
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan
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Garcia CM, Cunningham SJ. Role of clinical suspicion in pediatric blunt trauma patients with severe mechanisms of injury. Am J Emerg Med 2018; 36:105-109. [DOI: 10.1016/j.ajem.2017.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/19/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022] Open
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Stephens CQ, Boulos MC, Connelly CR, Gee A, Jafri M, Krishnaswami S. Limiting thoracic CT: a rule for use during initial pediatric trauma evaluation. J Pediatr Surg 2017; 52:2031-2037. [PMID: 28927984 DOI: 10.1016/j.jpedsurg.2017.08.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/28/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite increases in imaging guidelines for other body-regions during initial trauma assessment and the demonstrated utility of chest radiographs (CXR), guidelines for use of thoracic computed-tomography (TCT) are lacking. We hypothesized that TCT utilization had not decreased relative to other protocolized CTs, and mechanism and CXR could together predict significant injury independent of TCT. METHODS We performed a retrospective review of blunt trauma patients ≤18 y.o. (2007-2015) at two level-1 trauma centers who received chest imaging. Baseline characteristics and incidences of body region-specific CT were compared. Injury mechanism, intrathoracic pathology, and interventions among other data were examined (significance: p<0.05). RESULTS Although other body-region CT incidence decreased (p<0.05), TCT incidence did not change (p=0.65). Of the 2951 patients, 567 had both CXR and TCT, 933 received TCT-only, and 1451 had CXR-only. TCT altered management in 17 patients: 2 operations, 1 stent-placement, 1 medical management, 9 thoracostomy tube placements, and 4 negative diagnostic workups. All clinically significant changes were predicted by vehicle-related mechanism and abnormal CXR findings. CONCLUSIONS TCT utilization has not decreased over time. All meaningful interventions were predicted by CXR and mechanism of injury. We propose a rule, for prospective validation, reserving TCT for patients with abnormal CXR findings and severe vehicle-related trauma. LEVEL OF EVIDENCE Diagnostic study, Level III.
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Affiliation(s)
- Caroline Q Stephens
- Oregon Health & Science University, Department of Surgery, Division of Pediatric Surgery, Portland, OR.
| | - Meredith C Boulos
- Oregon Health & Science University, Department of Surgery, Division of Pediatric Surgery, Portland, OR
| | - Christopher R Connelly
- Oregon Health & Science University, Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Portland, OR
| | - Arvin Gee
- Oregon Health & Science University, Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Portland, OR
| | - Mubeen Jafri
- Oregon Health & Science University, Department of Surgery, Division of Pediatric Surgery, Portland, OR; Legacy Emanuel Medical Center-Randall Children's Hospital, Portland, OR
| | - Sanjay Krishnaswami
- Oregon Health & Science University, Department of Surgery, Division of Pediatric Surgery, Portland, OR; Legacy Emanuel Medical Center-Randall Children's Hospital, Portland, OR
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Abstract
Traumatic injuries to the thorax are common after both blunt and penetrating trauma. Emergency medicine physicians must be able to manage the initial resuscitation and diagnostic workup of these patients. This involves familiarity with a range of radiologic investigations and invasive bedside procedures, including resuscitative thoracotomy. This knowledge is critical to allow for rapid decision making when life-threatening injuries are encountered. This article explores the initial resuscitation and assessment of patients after thoracic trauma, discusses available imaging modalities, reviews frequently performed procedures, and provides an overview of the indications for operative intervention, while emphasizing the critical decision making throughout.
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Horst K, Andruszkow H, Weber CD, Pishnamaz M, Herren C, Zhi Q, Knobe M, Lefering R, Hildebrand F, Pape HC. Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients. PLoS One 2017; 12:e0186712. [PMID: 29049422 PMCID: PMC5648226 DOI: 10.1371/journal.pone.0186712] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023] Open
Abstract
Background and purpose Thoracic trauma remains to be a relevant injury to the polytraumatised patient. However, literature regarding how far changes in clinical guidelines for pre- and in-hospital trauma management and diagnostic procedures affect the outcome of multiple injured patients with severe chest injury during a long-term observation period is sparse. Methods Multiple traumatised patients (age≥16y) documented in the TraumaRegister DGU® (TR-DGU) from January 1st 2005 to December 31st 2014 with severe chest trauma (AIS≥3) were included in this study. Demographic data, the pattern of injury, injury severity, radiographic emergency procedures, indication for intubation, duration of mechanical ventilation, emergency surgery, occurrence of complications and mortality were evaluated per year and over time. Results A total of 16,773 patients were analysed. The use of whole body computer tomography increased (p<0.001), while the incidence of plain x-rays decreased (p<0.001). Furthermore, incidence of AISThorax = 3 graded injuries increased (p<0.001) while AISThorax = 4 decreased (p<0.001). Both, rate of patients being intubated at the time of ICU admission decreased (p<0.001) and the time of mechanical ventilation decreased (p<0.001). Additionally, need for emergency surgery, lung failure, sepsis, and multi organ failure all decreased (p<0.001). However, mortality remained unchanged. Interpretation Severity of severe chest trauma and associated complications decreased while diagnostics and treatment improved over time. However, mortality remained unchanged. Our results are in line with those expected in the context of the incidence of CT diagnostics, which has increased parallel to the clinical outcome Thus, our data demonstrate a positive trend in the treatment of patients with severe chest trauma.
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Affiliation(s)
- Klemens Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
- Harald Tscherne Research Laboratory, RWTH Aachen University, Aachen, Germany
- * E-mail:
| | - Hagen Andruszkow
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Christian D. Weber
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Christian Herren
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Qiao Zhi
- Harald Tscherne Research Laboratory, RWTH Aachen University, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Rolf Lefering
- IFOM - Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten / Herdecke University, Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
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Ittyachen AM, Vijayan A, Isac M. The forgotten view: Chest X-ray - Lateral view. Respir Med Case Rep 2017; 22:257-259. [PMID: 29021952 PMCID: PMC5633363 DOI: 10.1016/j.rmcr.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022] Open
Abstract
With CT (computed tomography) chest gaining more importance as a diagnostic tool, chest X-ray especially the lateral view is taken less commonly nowadays. Besides CT chest is also proven to be superior to chest X-ray in patients with major blunt trauma. We are presenting a 68-year old male who was partially treated from outside for a left sided pneumonia. He came to our hospital because of persisting chest pain. Chest X-ray, frontal view (postero-anterior) was almost normal except for a mild opacity in the left lower zone. CT scan of the chest revealed a fluid collection posteriorly enclosed within enhancing pleura. Chest X-ray, left lateral view showed a corresponding posterior pleural based opacity. We are presenting this case to highlight the importance of the lateral view of the chest X-ray. In selected cases there is still a role for the lateral view. With the three dimensional visualization provided by the CT, the lateral view of the chest may be easier to understand. Consequent to the initial diagnosis by CT further follow up can be done with the chest X-ray. In a limited way this mitigates unnecessary expenditure and more importantly prevents the patient from exposure to harmful radiation in the form of repeated CT.
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Tomas X, Facenda C, Vaz N, Castañeda EA, Del Amo M, Garcia-Diez AI, Pomes J. Thoracic wall trauma-misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging. Quant Imaging Med Surg 2017; 7:384-397. [PMID: 28932697 DOI: 10.21037/qims.2017.08.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Blunt injuries to the chest wall are an important chapter on emergency room (ER) departments, being the third most common injuries in trauma patients which ominous complications could appear. This article describes different types of traumatic events affecting the chest wall, which maybe misdiagnosed with conventional X-ray. Special emphasis has been done in computed tomography (CT) and multidetector CT (MDCT) imaging. This technique is considered the "gold-standard" for those traumatic patients, due to its fast acquisition covering the whole area of interest in axial plane, reconstructing multiplanar (2D, 3D) volume-rendered images with a superb quality and angiographic CT capabilities for evaluating vascular damage. Complementary techniques such as ultrasonography (US) and magnetic resonance imaging (MRI) may improve the diagnostic accuracy due to its great capacity in visualising soft-tissue trauma (muscle-tendinous tears) and subtle fractures. All these imaging methods have an important role in quantifying the severity of chest wall trauma. The findings of this study have been exposed with cases of our archives in a didactic way.
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Affiliation(s)
- Xavier Tomas
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Catherine Facenda
- Department of Radiology, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida 25198, Spain
| | - Nuno Vaz
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Edgar Augusto Castañeda
- Department of Radiology, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Pedro i Pons, 1, Sant Cugat del Vallés Barcelona 08190, Spain
| | - Montserrat Del Amo
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Ana Isabel Garcia-Diez
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Jaime Pomes
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
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Murphy CE, Raja AS, Baumann BM, Medak AJ, Langdorf MI, Nishijima DK, Hendey GW, Mower WR, Rodriguez RM. Rib Fracture Diagnosis in the Panscan Era. Ann Emerg Med 2017; 70:904-909. [PMID: 28559032 DOI: 10.1016/j.annemergmed.2017.04.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/22/2017] [Accepted: 04/04/2017] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury. METHODS We conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes. RESULTS Of 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4). CONCLUSION Under trauma imaging protocols that commonly incorporate chest CT, two thirds of rib fractures were observed on chest CT only. Patients with rib fractures had higher admission rates and mortality than those without rib fractures. First or second rib fractures were associated with significantly higher mortality and great vessel injury.
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Affiliation(s)
- Charles E Murphy
- Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Brigitte M Baumann
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
| | - Anthony J Medak
- Department of Emergency Medicine, University of California-San Diego School of Medicine, San Diego, CA
| | - Mark I Langdorf
- Department of Emergency Medicine, University of California-Irvine, Irvine, CA
| | - Daniel K Nishijima
- Department of Emergency Medicine, University of California-Davis, Davis, CA
| | - Gregory W Hendey
- Department of Emergency Medicine, University of California-San Francisco Fresno Medical Education Program, Fresno, CA
| | - William R Mower
- Department of Emergency Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA.
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Abstract
Rib fractures are a common and highly morbid finding in patients with blunt chest trauma. Over the past decade, a renewed interest in (and instrumentation for) rib fixation in this cohort has occurred. Stabilization of the chest wall in this setting, particularly when a flail segment is present, is associated with significant reductions in the rates of respiratory failure, pneumonia, ICU stay, and mortality. Thoracic surgeons should remain actively involved in this evolving area of our specialty to further optimize patient outcomes.
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Affiliation(s)
- John D Mitchell
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, USA
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Talbot BS, Gange CP, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. Radiographics 2017; 37:628-651. [DOI: 10.1148/rg.2017160100] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Brett S. Talbot
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Christopher P. Gange
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Apeksha Chaturvedi
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Nina Klionsky
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Susan K. Hobbs
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Abhishek Chaturvedi
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
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Sammy IA, Chatha H, Lecky F, Bouamra O, Fragoso-Iñiguez M, Sattout A, Hickey M, Edwards JE. Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database. Emerg Med J 2017; 34:205-211. [PMID: 28119351 PMCID: PMC5502246 DOI: 10.1136/emermed-2016-206077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 12/07/2016] [Accepted: 12/17/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. METHODS Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality. RESULTS There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19). CONCLUSION First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries.
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Affiliation(s)
- Ian Ayenga Sammy
- School of Health and Related Research, The University of Sheffield, Sheffield, UK .,Department of Clinical Surgical Sciences, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
| | - Hridesh Chatha
- Emergency Department, Aintree University Hospitals, Liverpool, UK
| | - Fiona Lecky
- The Trauma Audit and Research Network, University of Manchester, Salford, UK
| | - Omar Bouamra
- The Trauma Audit and Research Network, University of Manchester, Salford, UK
| | | | - Abdo Sattout
- Emergency Department, Aintree University Hospitals, Liverpool, UK
| | - Michael Hickey
- Emergency Department, Aintree University Hospitals, Liverpool, UK
| | - John E Edwards
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Kim SJ, Bista AB, Min YG, Kim EY, Park KJ, Kang DK, Sun JS. Usefulness of low dose chest CT for initial evaluation of blunt chest trauma. Medicine (Baltimore) 2017; 96:e5888. [PMID: 28079832 PMCID: PMC5266194 DOI: 10.1097/md.0000000000005888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/26/2022] Open
Abstract
We aimed to compare the diagnostic performance and inter-observer consistency between low dose chest CT (LDCT) and standard dose chest CT (SDCT) in the patients with blunt chest trauma.A total of 69 patients who met criteria indicative of blunt chest trauma (77% of male; age range, 16-85) were enrolled. All patients underwent LDCT without intravenous (IV) contrast and SDCT with IV contrast using parameters as following: LDCT, 40 mAs with automatic tube current modulation (ATCM) and 100 kVp (BMI <25, n = 51) or 120 kVp (BMI>25, n = 18); SDCT, 180 mAs with ATCM and 120 kVp. Transverse, coronal, sagittal images were reconstructed with 3-mm slice thickness without gap and provided for evaluation of 3 observers. Reference standard images (transverse, coronal, sagittal) were reconstructed using SDCT data with 1-mm slice thickness without gap. Reference standard was established by 2 experienced thoracic radiologists by consensus. Three observers independently evaluated each data set of LDCT and SDCT.Multiple-reader receiver operating characteristic analysis for comparing areas under the ROC curves demonstrated that there was no significant difference of diagnostic performance between LDCT and SDCT for the diagnosis of pulmonary injury, skeletal trauma, mediastinal injury, and chest wall injury (P > 0.05). The intraclass correlation coefficient was measured for inter-observer consistency and revealed that there was good inter-observer consistency in each examination of LDCT and SDCT for evaluation of blunt chest injury (0.8601-1.000). Aortic and upper abdominal injury could not be appropriately compared as LDCT was performed without using contrast materials and this was limitation of this study.The effective radiation dose of LDCT (average DLP = 1.52 mSv⋅mGy cm) was significantly lower than those of SDCT (7.21 mSv mGy cm).There is a great potential benefit to use of LDCT for initial evaluation of blunt chest trauma because LDCT could maintain diagnostic image quality as SDCT and provide significant radiation dose reduction. A further study of LDCT with IV contrast for evaluation of aortic and upper abdominal injury is needed.
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Affiliation(s)
- Sung Jung Kim
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | | | - Young Gi Min
- Department of Emergency Medicine, Ajou University Hospital, Suwon, Korea
| | - Eun Young Kim
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Kyung Joo Park
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Doo Kyoung Kang
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University Hospital, Suwon, Korea
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Chapman BC, Overbey DM, Tesfalidet F, Schramm K, Stovall RT, French A, Johnson JL, Burlew CC, Barnett C, Moore EE, Pieracci FM. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e37070. [PMID: 28144607 PMCID: PMC5253201 DOI: 10.5812/atr.37070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/10/2016] [Accepted: 09/04/2016] [Indexed: 12/01/2022]
Abstract
Background Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. Objectives The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Methods Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student’s t-test and chi-square analysis were used for comparison. Results We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. Conclusions The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.
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Affiliation(s)
- Brandon C. Chapman
- Department of Surgery, University of Colorado School of Medicine, Colorado, United States
- Corresponding author: Brandon C. Chapman, Department of Surgery, University of Colorado School of Medicine, Colorado, United States. Tel: +1-7207373858, E-mail:
| | - Douglas M. Overbey
- Department of Surgery, University of Colorado School of Medicine, Colorado, United States
| | - Feven Tesfalidet
- School of Medicine, University of Colorado, Colorado, United States
| | - Kristofer Schramm
- Department of Radiology, School of Medicine, University of Colorado, Colorado, United States
| | - Robert T. Stovall
- Department of Surgery, Denver Health Medical Center, Colorado, United States
| | - Andrew French
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United States
| | - Jeffrey L. Johnson
- Department of Surgery, Denver Health Medical Center, Colorado, United States
| | - Clay C. Burlew
- Department of Surgery, Denver Health Medical Center, Colorado, United States
| | - Carlton Barnett
- Department of Surgery, Denver Health Medical Center, Colorado, United States
| | - Ernest E. Moore
- Department of Surgery, Denver Health Medical Center, Colorado, United States
| | - Fredric M. Pieracci
- Department of Surgery, Denver Health Medical Center, Colorado, United States
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