Scientific paperFactors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces
Section snippets
Material and methods
All trauma patients (Injury Severity Score [ISS] ≥12) with CXRs and CT scans of the chest and/or abdomen who presented to our adult regional trauma center between June 30, 2002, and July 1, 2003, were identified via our trauma registry. Institutional review board ethics approval was obtained before commencement of this retrospective cohort study. Each of the paired CT scans and CXRs were then re-reviewed for the presence of any PTX.
CT scans were performed on a LightSpeed QX/I-Plus scanner (GE
Results
During the 12-month study period, 338 of 761 (44%) trauma patients underwent a CT scan. Of these, 185 (55%) patients had a complete chest, abdomen, and pelvis CT scan, whereas 152 (45%) had abdomen and pelvis imaging only. One patient also had a chest CT only. All patients had a supine CXR. The study group was 75.3 % male and injured by blunt trauma in 98.5% of cases. One hundred three PTXs were present in 89 patients. Fifty-seven (55%) were occult (Fig. 2). Considering only those with a
Comments
Clinicians are often required to diagnose PTXs when treating seriously injured patients. Large symptomatic PTXs should be detected clinically and treated solely on speculation in hemodynamically unstable patients. The supine AP chest radiograph remains the initial imaging test in most stable trauma patients. The nonradiologist usually diagnoses a PTX based on an appreciation of a visible pleural line, beyond which there is an absence of lung markings [31], [32]. Other potential diagnostic signs
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