Initial evaluation of chest trauma - Comparison of chest X-ray and computed tomography scan

OBJECTIVES: To investigate the contribution of computed tomography scan (CTS) to the initial evaluation of chest trauma. PATIENTS AND METHODS: We carried out a two-year prospective study in all the chest trauma patients admitted to ICU. They underwent both Chest X-ray (CXR) and CTS within 24 jours of admission. CXR and CTS images were read by achieving a consensus between two radiologists who were unaware of the results of the other investigation. Then we compared these findings with the treatment received by the patients in the ICU. RESULTS: From July 1, 1991 through July 1, 1993, 56 patients were included (21 with conventional CTS and 35 with helicoidal CTS). CTS demonstrated a significant number of pleural (p < 0.001), parenchymatous (p < 0.001), and mediastinal (p < 0.01) lesions that escaped detection on CXR (CTS+/CXR-lesions). Thoracic drainage was done in 16 patients because of abnormalities CTS+/CXR-(p < 0.01); six patients with CTS+/CXR-pulmonary contusions received Pressure Positive ventilation (p < 0.01); and four CTS+/CXR-lesions were treated surgically (p < 0.05). CONCLUSION: CTS adds significantly to the evaluation of chest trauma by allowing prompt, accurate assessment of lesions. in this study over 50% of these lesions required specific treatment during the ICU stay. (C) 1997, Masson, Paris.