Are routine repeat chest x-rays before leaving the trauma room useful?

Emerg Med J. 2010 Jul;27(7):522-5. doi: 10.1136/emj.2009.078519. Epub 2010 Apr 1.

Abstract

Background: Several guidelines advocate multiple chest x-rays during primary resuscitation of trauma patients. Some local hospital protocols include a repeat x-ray before leaving the trauma resuscitation room (TR). The purpose of this study was to determine the value of routine repeat x-rays.

Methods: One-year data of all radiological imaging in the TR were prospectively collected for all patients presenting to the TR of the hospital. The x-rays were counted and assessed and the findings were classified as either 'new injury detected', 'presence of intervention devices' or 'deterioration of previously detected injury'.

Results: A total of 674 patients were included. More than 75% had two x-rays. Eight (2.1%) new injuries without clinical relevance were found on the repeat x-ray after an initial normal x-ray. 61 patients (9%) had a repeat x-ray to verify the effect of an intervention or position of devices. In 28 patients (22%) with two abnormal x-rays, newly diagnosed injuries (n=9) or deterioration of known injuries (n=19) were found. In 411 patients (81%) the results of the repeat x-ray had no clinical consequences.

Conclusion: This study indicates that routine repeat chest x-rays can be omitted in trauma patients whose initial chest x-ray is normal.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Netherlands
  • Prospective Studies
  • Radiography, Thoracic*
  • Trauma Centers / statistics & numerical data
  • Unnecessary Procedures
  • Wounds and Injuries / diagnostic imaging*