Evaluation of the utility of computed tomography in the initial assessmentof the critical care patient with chest trauma

Objective: To determine the utility of thoracic computed tomography (TCT) i n the initial assessment of critically ill patients with chest injuries. Design: Prospective observational study of cohorts. Setting: Trauma intensive care unit (ICU) of a Spanish Level III hospital ( US equivalent: Level I). Patients. Three hundred seventy-five patients with chest injuries were stud ied, grouped into two cohorts according to whether they underwent admission TCT (exposed cohort, group I, n = 104) or not (unexposed cohort, group II, n = 271). Interventions: None. Measurements and Main Results: Demographic data, initial severity scores, a nd chest radiograph (CXR)-based diagnosis were collected in all patients as independent variables. In patients of group I, we also recorded the TCT-ba sed diagnosis and any incidents, complications, or therapy changes resultin g from the TCT. The need for and duration of mechanical ventilation, length of ICU stay, and ICU mortality were gathered in the whole sample as depend ent variables. The admission data were similar in the two groups, except fo r a higher Injury Severity Score (ISS) and thoracic ISS in group I. TCT pro ved to be more sensitive than CXR in detecting pulmonary contusion, hemotho rax, pneumothorax, and vertebral fractures and in identifying the faulty pl acement of chest drainage tubes. TCT findings induced therapy changes in si milar to 30% of patients in group I. In the other dependent variables studi ed, there were no differences between the two groups. In the multivariate a nalysis, the TCT screening had no effects on the time on mechanical ventila tion, length of ICU stay, or mortality. Conclusions: TCT detects more chest injuries in trauma patients than does C XR and induces therapy changes in a considerable number of patients. Howeve r, this does not translate into an improvement in clinical outcomes.