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Added Value of Routine Chest MDCT After Blunt Trauma: Evaluation of Additional Findings and Impact on Patient Management

Monique Brink1, Jaap Deunk2, Helena M. Dekker1, Digna R. Kool1, Michael J. R. Edwards2, Arie B. van Vugt2 and Johan G. Blickman1

1 Department of Diagnostic Imaging, Radboud University Nijmegen Medical Centre, Internal number (Huispost) 667, Geert Groote plein 10, 6500 HB Nijmegen, The Netherlands.
2 Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.


Figure 1
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  		Fig. 1 —Diagram shows patient flow for subject selection: 551 trauma patients fulfilled inclusion criteria for study. Thirty-one patients were excluded because of severe shock (n = 11), neurosurgical emergency (n = 5), death soon after arrival (n = 14), or pregnancy (n = 1). Fifty-six patients were not included because of protocol violation. For analysis, 464 patients were included. Gray boxes indicate patient groups that were compared. ISS = injury severity score, CR = conventional radiography.

 

Figure 2
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  		Fig. 2A —Clustered bar charts show extent and severity of chest injuries that were diagnosed on MDCT but missed on conventional radiography. Number and severity of pneumothoraces (A), hemothoraces (B), and pulmonary contusions (C), and number of rib fractures (D) are shown for both selective MDCT algorithm (black bars) and routine MDCT algorithm (white bars). Differences between black and white bars illustrate number of injuries that would have been missed if only selective MDCT algorithm had been used. One patient could have more injures. Number of patients with rib fractures includes patients in whom presence of rib fractures was already diagnosed at conventional radiography but in whom there was discrepancy in number of rib fractures.

 

Figure 3
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  		Fig. 2B —Clustered bar charts show extent and severity of chest injuries that were diagnosed on MDCT but missed on conventional radiography. Number and severity of pneumothoraces (A), hemothoraces (B), and pulmonary contusions (C), and number of rib fractures (D) are shown for both selective MDCT algorithm (black bars) and routine MDCT algorithm (white bars). Differences between black and white bars illustrate number of injuries that would have been missed if only selective MDCT algorithm had been used. One patient could have more injures. Number of patients with rib fractures includes patients in whom presence of rib fractures was already diagnosed at conventional radiography but in whom there was discrepancy in number of rib fractures.

 

Figure 4
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  		Fig. 2C —Clustered bar charts show extent and severity of chest injuries that were diagnosed on MDCT but missed on conventional radiography. Number and severity of pneumothoraces (A), hemothoraces (B), and pulmonary contusions (C), and number of rib fractures (D) are shown for both selective MDCT algorithm (black bars) and routine MDCT algorithm (white bars). Differences between black and white bars illustrate number of injuries that would have been missed if only selective MDCT algorithm had been used. One patient could have more injures. Number of patients with rib fractures includes patients in whom presence of rib fractures was already diagnosed at conventional radiography but in whom there was discrepancy in number of rib fractures.

 

Figure 5
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  		Fig. 2D —Clustered bar charts show extent and severity of chest injuries that were diagnosed on MDCT but missed on conventional radiography. Number and severity of pneumothoraces (A), hemothoraces (B), and pulmonary contusions (C), and number of rib fractures (D) are shown for both selective MDCT algorithm (black bars) and routine MDCT algorithm (white bars). Differences between black and white bars illustrate number of injuries that would have been missed if only selective MDCT algorithm had been used. One patient could have more injures. Number of patients with rib fractures includes patients in whom presence of rib fractures was already diagnosed at conventional radiography but in whom there was discrepancy in number of rib fractures.

 

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