Ludo Beenen MD, Presenter: Nothing to Disclose

Cornelia Maria Schaefer-Prokop MD, Abstract Co-Author: Nothing to Disclose

To assess the diagnostic efficiency of routine short-term follow-up chest radiographs (CXR) in a polytrauma algorithm.

In our level-I trauma-center the initial imaging protocol consists of anterior-posterior CXR, pelvic X-ray and abdominal ultrasound. This primary survey is performed immediately after arrival in the ER with the patient still on a spine board. A second CXR is routinely obtained after 30-60 min in those patients that had not underwent immediate intervention, surgery or further diagnostics by computed tomography after the initial survey. We evaluated the chest radiographs of all consecutive trauma patients (n= 616) examined over a 12-month time period between November 2005 and 2006. One experienced chest and one emergency radiologist evaluated the two initial chest radiographs in consensus having all further imaging studies, follow-up and clinical history available. Evaluation criteria for either CXR were overall image quality (score 1 = good, 2 = sufficient, 3 = insufficient) and reasons for reduced quality. Presence of new diagnostic information (yes or no) and impact on therapeutic management (yes or no) was scored for the second CXR.

Of all patients 12% underwent immediate CT, interventional and/or surgical procedures prohibiting a second CXR, thus 88% underwent two CXR within one hour. One forth of these CXR verified correct positioning of monitoring materials. 24% of the second CXR had a superior image quality due to better inspiration depth (12%), more complete display of anatomy (8%) or lack of superimposing structures (4%). In 55% the first image was judged as definitely normal. In only one of these patients, the second image demonstrated a small abnormality (contusion) not visible on the first radiograph. In case of a normal first radiograph, the second radiograph never had an impact on management.

If the first CXR is of adequate quality and does securely rule-out pathology, the diagnostic yield of a second CXR is negligible.

These results confirm previous publications that found that chest CT is not necessary in trauma patients with entirely normal chest radiographs.

Beenen, L, Schaefer-Prokop, C, Diagnostic Efficiency of Repeat CXR in an Emergency Setting.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5016611.html