Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas

Abstract

Background: Since the diagnostic yield of chest X-ray (CXR) is not high enough, when it is ordered for all the multiple trauma patients, this study was aimed to evaluate the relationship between clinical and CXR findings in order to formulate a clinical decision rule to prevent unnecessary CXR in these patients. Methods: Stable multiple blunt trauma patients referring to the ED were included. The clinical and radiographic findings of all the patients were collected and the relationships between these variables analysed. Finally, based on the regression coefficients (ß) of the variables, the Thoracic Injury Ruleout Criteria (TIRC) were designed. Results: A total of 2607 patients were included (males: 78.9%, mean age: 34.1 ± 15.0 years). Age over 60 (ß = 0.8; 95% CI: 0.27-1.34; P = 0.003), crepitation (ß = 4.33; 95% CI: 1.65-7.0; P < 0.001), loss of consciousness (ß = 3.16; 95% CI: 2.44-3.88; P < 0.001), decrease in pulmonary sounds (ß = 2.67; 95% CI: 1.73-3.6; P < 0.001), chest wall pain (ß = 2.12; 95% CI: 1.63-2.61; P < 0.001) and tenderness (ß = 1.78; 95% CI: 1.26-2.27; P < 0.001), dyspnea (ß = 1.3; 95% CI: 0.41-2.18; P = 0.004) and abrasion (ß = 0.5; 95% CI: 0.22-0.83; P = 0.03) were independent factors predicting thoracic injury. CXR in stable conscious multiple blunt trauma patients under 60 years, without chest wall pain and tenderness, decrease in pulmonary sounds, crepitation, skin abrasion, and dyspnea did not provide any additional findings. Conclusions: Based on TIRC, it seems that CXR in stable multiple blunt trauma patients who are conscious and under 60 and have no decrease in pulmonary sounds, no dyspnea, no thoracic skin abrasion, and no crepitation can be ignored.