Evaluation of PERSH Criteria to Avoid Unnecessary Chest X-ray in Patients with Blunt Chest Trauma: A Qualitative Study

Abstract

Background: Chest X-rays (CXRs) are traditionally performed to determine intra-thoracic injuries in all blunt chest trauma patients in Shahid Bahonar hospital in Kerman. As there are some disadvantages upon CXR and radiation exposure, therefore, this study aimed to evaluate the role of CXR in the diagnosis of intra-thoracic injuries caused by any blunt chest trauma. Methods: This prospective qualitative study was conducted on all patients over 16 years old with blunt chest trauma. Unstable patients with GCS<13/15, RTS<12, dyspnea, intratracheal intubation, pregnancy, intoxication, an accident time longer than 24 hours, patients referred from other centers, and patients who did not agree to participate were excluded. All patients underwent routine CXR and followed up by telephone call 48 hours after admission. Data were analyzed through SPSS version 16. Results: Of 2850 patients, 1320 cases were encountered and screened using screening tools. Mean age of patients was 31.6±15.6 years. From all, 1022 (67.4%) patients were male. Motor vehicle accident [439 (28.9%)] and motorcycle crash [437 (28.8%)] were the most frequent causes of trauma. The mean accident-visit time was 181.2±72.7 min. There was no trauma-related pathogenic finding in CXRs. None of the patients needed any further emergency treatment. Conclusion:Some parameters may be used to rule out intra-thoracic injuries, and accordingly, decrease CXR performance. Four areas including physical examination (PE), Revised Trauma Score (R), oxygen saturation (S), and history taking (H), were explained and presented as PERSH criteria. Therefore, there is no need to perform CXR as a standard process of care in stable multiple trauma patients who have negative PERSH criteria.