IJSR - International Journal of Scientific Research

Dr Animesh Vatsa; Dr T J Rappai; Dr Rahul Pandey; Dr KM Mehdi Hafiz Laskar; Dr Pawan Sharma

Volume : VIII, Issue : VIII, August - 2019

Utility of Chest X–ray in blunt trauma chest in a tertiary care trauma center

Dr Animesh Vatsa, Dr T J Rappai, Dr Rahul Pandey, Dr Km Mehdi Hafiz Laskar, Dr Pawan Sharma

Abstract :

Introduction: Chest X–Ray (CXR) is routinely employed as the first diagnostic modality in chest trauma but some potentially life–threatening injuries are frequently missed on CXR. Non contrast computed tomography (NCCT) scan is a better diagnostic tool in blunt trauma chest. We studied the diagnostic accuracy of CXR in blunt trauma chest patients. Methodology: 100 patients of blunt trauma chest were included. All underwent CXR and NCCT chest. Findings of NCCT chest were considered as standard for CXR findings. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio positive (positive LR), likelihood ratio negative (negative LR) and accuracy were calculated for CXR. Results: CXR had 100% sensitivity, PPV and accuracy in detecting rib fractures. The sensitivity for hemothorax, pneumothorax and other injuries (lung contusion, thoracolumbar vertea fractures, diaphragmatic injuries, surgical emphysema and pneumomediastinum) were 68.75%, 71.64% and 15.38%. For hemothorax it had specificity and PPV of 100%, negative LR of 0.31, NPV of 11.76% and accuracy of 70%. For detecting pneumothorax, CXR had sensitivity of 71.64%%, specificity and PPV of 100%, negative LR of 0.28, NPV of 63.46% and accuracy of 81.00%. For other lung injuries CXR had specificity and PPV of 100%, negative LR of 0.85, NPV of 77.08% and accuracy of 78.00%. In 71% patients, NCCT identified significant chest injury intricacies that were missed on CXR. Conclusion: CXR performed alone during primary survey is not a reliable tool for evaluation of blunt trauma chest. NCCT chest should be performed and included as a protocol in all hemodynamically stable cases of blunt trauma chest.