Routine CT- Chest in Primary Evaluation of the Major Blunt Trauma Patients; Pros and Cons

Abstract

Trauma is a major worldwide public health problem and it is one of the leading causes of death in both industrialized and developing countries. Injuries of the thorax are a major cause of morbidity and mortality in blunt trauma patients. Approximately 20% of traumarelated deaths are attributable to chest injuries (LoCicero and Mattox, 1989). In trauma patients, a clear history is rarely available as most patients are confused, unconscious or even anesthetized and the clinical findings have been shown to be equivocal or misleading in 20–50% of victims of blunt polytrauma (Poletti et al., 2002). Consequently, radiology plays a major role in evaluation of the trauma patient. The Advanced Trauma Life Support (ATLS 2004) course recommended performing the plain film radiography of the chest, abdomen, and cervical spine in all the blunt trauma patients. Nowadays, Chest computed tomography (CCT) is being used with increasing frequency in the evaluation of blunt chest trauma. CCT frequently detects injuries not seen on routine initial chest x-ray (CxR) (occult findings). However, in the vast majority of patients the impact of these findings on patient management is debatable (Blostein et al., 1997, Hamad and regal, 2010). CT is used primarily to assess for traumatic aortic injuries but also has been shown to be useful in the evaluation of skeletal, pulmonary, airway, and diaphragmatic injuries.