Significance of findings of both emergency chest X-ray and thoracic computed tomography routinely performed at the emergency unit in 102 polytrauma patients - A prospective study.

Purpose: To evaluate prospectively whether and to what extent both thoracic computed tomography (Tx-CT) and supine X-ray of the chest (Rx-Tx) are able to show additional findings that are therapeutically relevant. Patients an d Methods: According to a fixed study protocol, we performed Rx-Tx and Tx-C T in 102 consecutive, haemodynamically stable polytrauma patients (mean age , 41.2 yrs; age range, 12 - 93 yrs). Findings of therapeutical relevance dr awn from both Tx-CT and Rx-Tx, and urgent interventions indicated by an att ending trauma team were documented on a standardized evaluation sheet immed iately. Any change in the patient's management that is different from routi ne life-saving procedures, and any therapeutical intervention done in the e mergency room or elsewhere (operating theatre, angiographic facility) were considered therapeutically relevant. Results: Of 102 patients, 43 (42.2%) h ad a total of 51 therapeutically relevant findings. Rx-Tx alone yielded 23 relevant findings (45.1%) in 23 patients (22.5%). Of them, Tx-CT has shown additional important findings in 7 patients (30.4%). When Tx-CT alone is co nsidered, it revealed 22 new findings of therapeutical relevance (43.2%) in 20 patients (46.5%). Altogether, Tx-CT was able to show 30 relevant findin gs in 27 patients, i.e., there was a therapeutical benefit for 26.5% of all polytrauma patients included. Most frequently, there was a need for chest- tube insertion (n = 29). Conclusions: Polytrauma patients if haemodynamical ly stable may profit from computed tomography of the chest when therapeutic ally relevant thoracic injuries are looked for or early therapeutical inter ventions are to be checked. However, chest X-ray should stay as a "front-li ne" screening method because of its superbly quick feasibility and availabi lity.