INITIAL EVALUATION OF CHEST TRAUMA - COMPARISON OF CHEST-X-RAY AND COMPUTED-TOMOGRAPHY SCAN

OBJECTIVES: To investigate the contribution of computed tomography sca n (CTS) to the initial evaluation of chest trauma. PATIENTS AND METHOD S: We carried out a two-year prospective study in all the chest trauma patients admitted to ICU. They underwent both Chest X-ray (CXR) and C TS within 24 jours of admission. CXR and CTS images were read by achie ving a consensus between two radiologists who were unaware of the resu lts of the other investigation. Then we compared these findings with t he treatment received by the patients in the ICU. RESULTS: From July 1 , 1991 through July 1, 1993, 56 patients were included (21 with conven tional CTS and 35 with helicoidal CTS). CTS demonstrated a significant number of pleural (p < 0.001), parenchymatous (p < 0.001), and medias tinal (p < 0.01) lesions that escaped detection on CXR (CTS+/CXR-lesio ns). Thoracic drainage was done in 16 patients because of abnormalitie s CTS+/CXR-(p < 0.01); six patients with CTS+/CXR-pulmonary contusions received Pressure Positive ventilation (p < 0.01); and four CTS+/CXR- lesions were treated surgically (p < 0.05). CONCLUSION: CTS adds signi ficantly to the evaluation of chest trauma by allowing prompt, accurat e assessment of lesions. in this study over 50% of these lesions requi red specific treatment during the ICU stay. (C) 1997, Masson, Paris.