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Original Articles: General Thoracic

Chest Computed Tomography for Penetrating Thoracic Trauma After Normal Screening Chest Roentgenogram

^a Department of Surgery, Division of General Surgery, University of Illinois at Mount Sinai Hospital, Chicago, Illinois
^b Department of Surgery, Division of Trauma, University of Illinois at Mount Sinai Hospital, Chicago, Illinois
^c Department of Surgery, Division of Thoracic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
^d Department of Surgery, Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois

Accepted for publication February 20, 2012.

^_* Address correspondence to Dr Mollberg, Department of Surgery, Mt. Sinai Hospital, 15th at California Ave, Chicago, IL 60608 (Email: nathan.mollberg{at}gmail.com).

Presented at the Poster Session of the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012

Background: Chest computed tomography (CCT) is a method of screening for intrathoracic injuries in hemodynamically stable patients with penetrating thoracic trauma. The objective of this study was to examine the changes in utilization of CCT over time and evaluate its contribution to guiding therapeutic intervention.

Methods: A level 1 trauma center registry was queried between 2006 and 2011. Patients undergoing CCT in the emergency department after penetrating thoracic trauma as well as patients undergoing thoracic operations for penetrating thoracic trauma were identified. Patient demographics, operative indications, use of CCT, injuries, and hospital admissions were analyzed.

Results: In all, 617 patients had CCTs performed, of whom 61.1% (371 of 617) had a normal screening plain chest radiograph (CXR). In 14.0% (51 of 371) of these cases, the CCT revealed findings not detected on screening CXR. The majority of these injuries were occult pneumothoraces or hemothoraces (84.3%; 43 of 51), of which 27 (62.8%) underwent tube thoracostomy. In only 0.5% (2 of 371), did the results of CCT alone lead to an operative indication: exploration for hemopericardium. The use of CCT in our patients significantly increased overall (28.8% to 71.4%) as well as after a normal screening CXR (23.3% to 74.6%) over the study period.

Conclusions: The use of CCT for penetrating thoracic trauma increased 3.5-fold during the study period with a concurrent increase in findings of uncertain clinical significance. Patients with a normal screening CXR should be triaged with 3-hour delayed CXR, serial physical examinations, and focused assessment with sonography for trauma; and CCT should only be used selectively as a diagnostic modality.