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Evaluating validity of clinical criteria for requesting chest X-rays in trauma patients referred to emergency room

Background: Our goal was to identify the clinical criteria for requesting the chest X-ray in patients with blunt trauma and whether its findings such as clinical signs with a high sensitivity could be used to codify the final criteria. Materials and Methods: 386 patients with multiple trauma or blunt chest trauma examined by a physician and the injury mechanism, vital signs, O 2 saturation, auscultation findings, abrasions and ecchymosis, crepitation, tenderness on palpation, and pain on lateral compression were noted. The physician′s clinical judgment on the necessity of a chest X-ray was also noted in a questionnaire. After taking the X-ray, a digital photo was taken and showed to a radiologist to report any significant chest injury. Data were collected and the positive and negative predictive values, sensitivity and specificity were estimated. Results: 350 males (90.9%) and 35 females (9.1%) with the mean age of 47.1 ± 15.5 years old were evaluated. Falling down (37.7%) was the major mechanism of injury and chest pain (48%) the first complaint of patients. In 87.3% of the chest X-rays, there was no abnormal finding. Among several pathological findings in the chest X-rays, hemothorax, and rib fracture (each with 3.4% prevalence) had a higher prevalence. Tenderness on palpation with clinical judgment had a higher sensitivity about 95% and higher specificity about 100% in crepitation detected. Conclusion: Results showed the combination of positive chest pain and tachypnea in the patients could identify a significant chest injury with 100% sensitivity. More studies on this issue are warranted.