GRANADA, SPAIN--Thoracic computed tomography (CT) detects more chest injuries in trauma patients than chest radiography does, Guerrero López et al have found.[1] In their recent study, the thoracic CT findings often led to changes in therapy, but these alterations did not appear to improve clinical outcomes.

Francisco Guerrero López, MD, and colleagues prospectively studied 365 consecutive patients with chest injuries who were admitted to the intensive care unit at the Virgin de las Nieves University Hospital in Granada, Spain. All of the patients underwent physical examination, chest radiography, and initial stabilization maneuvers in the emergency area.

Thoracic CT was performed on 104 patients who were suspected of having potentially serious chest injuries that were not completely diagnosed during the initial assessment. A third-generation CT scanner was used. The only significant difference between patients with and without CT scans was a higher Injury Severity Score (ISS) and thoracic ISS in the former group.

CT MORE SENSITIVE THAN CHEST FILMS

Thoracic CT was more sensitive than chest films in detecting the following abnormalities: vertebral fractures, soft tissue lesions, chest drainage tubes in faulty position, pulmonary contusions, hemothorax, pneumothorax, and widened mediastinum (see Figures).

Physicians changed treatment because of CT findings in about 30% of the cases. Major therapeutic changes included drainage of tension pneumothoraces in three patients, surgical repair of a traumatic aortic rupture in one patient, and laparotomy to correct a left diaphragmatic rupture in two patients. Minor changes included drainage of a pneumothorax and/or hemothorax, as well as repositioning of a chest tube.

However, these changes did not appear to affect outcome; the patients who underwent thoracic CT had a similar duration of mechanical ventilation, length of intensive care unit stay, and mortality rate as did the patients who received chest films alone.

IMPLICATIONS

"We think that thoracic CT may be indicated when there is a serious suspicion of a severe injury that cannot be confirmed or ruled out by chest film," Dr. Guerrero López said in an interview with PULMONARY REVIEWS. "For example, neither a thoracic vertebral fracture nor a large pneumothorax or hemothorax may be visible on the chest radiograph because of the patient's supine position or because they are masked by a chest wall emphysema."

"Routine use of chest CT as a screening exam in blunt thoracic trauma is not necessary, however, because the majority of lesions not visible on plain chest films are not life threatening," Dr. Guerrero López added. Furthermore, "Chest CT (with a third-generation CT scanner) is a time-consuming process that lengthens the delay between injury and treatment."

The researchers suggested that future studies should investigate the outcomes of therapy changes induced by a helical CT rather than a third-generation CT scanner. "Helical CT offers greater resolution and faster speed in image acquisition," said Dr. Guerrero López.

--Kristin Della Volpe

Reference
1. Guerrero-López F, Vazquez-Mata G, Alcazar-Romero PP, et al. Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma. Crit Care Med. 2000;28:1370-1375.

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