Evaluation of Conventional Chest X-Ray in the Trauma Bay

Abstract

Introduction: The Advanced Trauma Life Support (ATLS™) provides guidelines for the initial management of major trauma patients, which have become the golden standard at Sahlgrenska University Hospital (SU/S). These guidelines recommend conventional chest x-ray (CXR) to be used in the trauma bay. Extended Focused Assessment Sonography in Trauma (eFAST) has in recent years become more frequently used as an alternative to CXR. Since almost all trauma patients are subject to a trauma computed tomography (CT) scan, the value of CXR in the trauma bay has been questioned. Aim: The aim of this study was to evaluate the usage of CXR to diagnose pneumo- and hemothoraces in the trauma bay at SU/S. Methods: The study was partly retrospective, where an expert radiologist examined the quality of all CXRs taken at SU/S between 2016 and 2018. Also, findings on CXR as compared to CT were compared. Additionally, all tube thoracostomies placed during the same period were investigated. Finally, a survey, where surgeons and radiologists assessed CXR-images to assess their ability to diagnose pneumo- and/or hemothoraces, was performed. Results: A total of 77 chest x-ray (CXR) images were obtained in the trauma bay at SU/S between 2016 to 2018. Of these, 74% had one or more remarks regarding quality. Comparison between findings on CXR and following trauma CT showed a sensitivity of 50% regarding pneumo- and/or hemothoraces of clinical relevance. Based on CXR findings a chest drain was placed in 10 patients. The survey showed that surgeons correctly assessed the presence of pneumothorax and/or pleural fluid in 66% of the cases. Conclusions: The findings in this study suggest that the value of current routines as well as radiography equipment in the trauma bay is limited.