Need For Radiography Research Articles

The Potential of a Saliva Test for Screening of Alveolar Bone Resorption.

Oral health screening is important for maintaining and improving quality of life. The present study aimed to determine whether patients with a certain level of alveolar bone resorption could be screened by salivary bacterial test along with their background information. Saliva samples were collected from 977 Japanese patients, and the counts of each red-complex, that is, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, were measured using quantitative polymerase chain reaction analysis. Mean bone crest levels (BCLs) were measured using a full-mouth periapical radiograph. Multiple logistic regression analysis was used to determine associations between BCLs (1.5-4.0 mm in 0.5 mm increments) and explanatory variables, such as the number of each red-complex bacteria and the patients' age, sex, number of teeth, stimulated saliva volume, and smoking habits. When the cutoff BCL value was set at 3.0 mm, the area under the curve, sensitivity, and specificity values were optimal at 0.86, 0.82, and 0.76, respectively. In addition, all tested explanatory variables, except sex and T. denticola count, were significantly associated with BCLs according to a likelihood ratio test (p < 0.05). Additionally, the odds ratio (OR) was substantially increased when a patient was >40 years old and the bacterial count of P. gingivalis was >107 cells/µL (OR: >6). Thus, P. gingivalis count and patients' background information were significantly associated with the presence of a certain amount of bone resorption, suggesting that it may be possible to screen bone resorption without the need for radiography or oral examination.

MODELING AND OPTIMIZATION OF HPGE DETECTOR GC0518 USING MCNP5 CODE.

For precise modeling of a high purity germanium (HPGe) detector, detailed knowledge of its geometry is necessary. Unfortunately, some of the detector geometric parameters are often not available. This study suggests simple procedures for determining geometry without the need for radiography. The study considers the HPGe detector GC0518 manufactured by Mirion. The detector datasheet is available, but the uncertainties do not allow the detector to be modeled without additional corrections. The detector was modeled using MCNP5 code and the results were compared with calibration point sources and Marinelli beakers measurements. We also performed measurements to obtain information on the germanium dead layer, crystal holder shape, inner hole shape and radii of the crystal edges. Then the model was optimized according to the measurements. Finally, the full energy peak efficiencies were evaluated. The relative differences between the measured and calculated efficiencies are less than 4.5% for point sources and 5.4% for Marinelli beakers.

Diagnosing Sever Disease: Overview Of The Literature

Calcaneal apophysitis is a condition known also sever disease. Recent knowledge supports overuse injury as an underlying etiology. The typical presentation is bilateral or unilateral heel pain during an activity in an adolescent who had a history of new-onset sports activity. We should take a detailed history, careful examination and simple laboratory tests for the patients with painful heels. If the patient's symptoms and examinations fit with calcaneal apophysitis some authors believe no need for radiography, unlike routine practice. MRI and ultrasound can also provide helpful diagnostic images but are neither cost-effective nor easy accessible at the first stage. We need to improve our knowledge and confidence in the clinical workup. Obviously further investigations require to reveal an ideal diagnostic algorithm.

EVALUATION OF THE EFFECT OF INTRAVENOUS ACETAMINOPHEN IN REDUCING THE NEED FOR RADIOGRAPHY IN PATIENTS WITH LUMBOSACRAL INJURIES ADMITTED TO HOSPITAL EMERGENCY DEPARTMENT

Introduction: Lower back pain is one of the most common symptoms in patients referred to emergency department. Physicians should always keep in mind avoiding unnecessary radiographs for patients. On the other hand, the specificity and sensitivity of midline tenderness for lumbosacral spinal fracture and injury following analgesic analgesia is uncertain, therefore, this study investigated the effect of intravenous acetaminophen in reducing the need for radiography in patients referred to the emergency department with lumbosacral trauma. Materials and Methods: All patients with lumbosacral trauma referred to the emergency department, who had midline tenderness, were evaluated for the first 6 months from September 2017 until the end of March 2018. For these patients, acetaminophen at a dose of 15 mg/kg was given intravenously. Then, lumbosacral area CT imaging was performed by radiology technician. Furthermore, 60 minutes after intravenous acetaminophen, patients were again examined for lumbosacral midline tenderness and the results were compared with imaging. Data were analyzed by SPSS-17 software. Results: 421 patients suffering from blunt lumbar trauma with midline tenderness were enrolled. Mean age of patients was determined to be 34.27 (SD: 9.25). In terms of gender, 284 (67.5%) patients were male and 137 (32.5%) were female. The sensitivity and specificity for midline tenderness after intravenous acetaminophen were 71.43% and 96.97%, respectively. Moreover, positive and negative predictive values were reported as 83.33% and 94.12%, respectively. Conclusion: The results of the present study indicate that the presence of midline tenderness in the lumbosacral area after receiving intravenous acetaminophen in patients with lumbosacral trauma is highly suggestive of fracture and tenderness elimination largely denies the existence of fractures, but these findings are not conclusive.

Correction to: The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study.

The original version of this article unfortunately contained a mistake. The spelling of the J. Carel Goslings' name was incorrect. The correct information is given above.

The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

PurposeWhile most patients with wrist trauma are routinely referred for radiography, around 50% of these radiographs show no fracture. To avoid unnecessary radiographs, the Amsterdam Wrist Rules (AWR) have previously been developed and validated. The aim of the current study was to evaluate the effect of the implementation of the AWR at the Emergency Department (ED).MethodsIn a before-and-after comparative prospective cohort study, all consecutive adult patients with acute wrist trauma presenting at the ED of four hospitals were included. Primary outcome was the number of wrist radiographs before and after implementation of the AWR. Secondary outcomes were the number of clinically relevant missed fractures, the overall length of stay in the ED, physician compliance regarding the AWR, and patient satisfaction and experience with the care received at the ED.ResultsA total of 402 patients were included. The absolute reduction in wrist radiographs after implementation was 15% (p < 0.001). One clinically irrelevant fracture was missed. Non-fracture patients without wrist radiography due to the AWR spent 34 min less time in the ED compared with non-fracture patients who had a wrist radiograph (p = 0.015). The physicians adhered to the AWR in 36% of patients. Of all patients who did not receive a radiographic examination of the wrist, 87% were satisfied.ConclusionImplementation of the AWR safely reduces the amount of wrist radiographs in selected patients and consequently reducing the length of stay in the ED.

Quebec Decision Rule in Determining the Need for Radiography in Reduction of Shoulder Dislocation; a Diagnostic Accuracy Study.

The Quebec Decision Rule (QDR) has been developed for deciding on the necessity of radiography for patients with shoulder dislocation. This study aimed to investigate the diagnostic value of QDR in this regard. This diagnostic accuracy study was conducted on patients with shoulder dislocation visiting the emergency department. After filling out the QDR-based checklist for all patients, they underwent radiography and the obtained radiography results were compared to QDR-based clinical diagnostic findings. 143 patients with the mean age of 32.1±12 years were evaluated (88.8% males). Sensitivity, specificity, and positive and negative predictive values of QDR were 50%, 58.2%, 3.3%, and 97.6%, respectively. The sensitivity and specificity were 100% and 50% in patients >40 years old, and 33.3% and 59.8% in those <40 years old. These indices were 33.3% and 60.4%, respectively, in the male sex and 100% and 40% in the female sex. ‌ Quebec decision rule holds promise to diagnose concomitant fractures in patients over the age of 40 with 100% sensitivity, thereby reducing the number of radiographies by 50% without causing diagnostic errors. In contrast, this criterion proved inefficient in patients younger than 40. ‌.

The Relationship between Clinical Findings of Shoulder Joint with Bone Damage of Shoulder Joint in Patients with Isolated Shoulder Blunt Trauma.

BACKGROUND:Due to the prevalence of shoulder injuries among athletes and other people and the prevalence of radiography for these injuries, there are still no valid criteria for indication of doing shoulder radiography.AIM:This study aimed to examine the relationship between some signs and clinical examinations of the shoulder with shoulder bone injuries and the need for radiography.METHODS:This is a cross-sectional study. All patients aged 18-70 years who referred to the emergency ward of Imam Reza and Hasheminejad Hospital in the year 2014 due to blunt trauma and had criteria for entering the study and lacking exclusion criteria were included in the study process. Data on clinical symptoms, radiographic results, and final diagnosis were extracted from the patients’ records through a questionnaire and analysed statistically.RESULTS:There was a significant relationship between the clinical signs of patients Existence of ecchymosis in the shoulder fractures with glenoid and humerus fractures (p = 0.029, p = 0.004 respectively). There was also a significant relationship between clavicle fracture and limitation in shoulder rotation and abduction (p = 0.000 and p = 0.001 respectively). Other clinical symptoms did not show any significant relationship with radiographs indicative of the problem requiring specific treatment.CONCLUSION:Although it is possible to define critters based on clinical symptoms that reduce the need for unnecessary radiographs that the does not reliably help inpatient treatment, but finding these critters to indicate the performance of the graphs in shoulder injuries requires further studies with the higher population and more clinical variables.

EVALUATION OF THE PROGRESSION OF AXIAL SPONDYLOARTHRITIS IN THE EARLY STAGES OF THE DISEASE IN REAL CLINICAL PRACTICE: THE POSSIBILITIES OF USING THE SUMMARY SCORE OF RADIOGRAPHIC SACROILIITIS

The currently used methods for evaluating the progression of structural damages in early axial spondyloarthritis (axSpA) are little suitable to real practice since they require specially trained radiologists and increase a patient's exposure to radiation due to the need for radiography of three regions of the axial skeleton. In addition, the first radiological bone changes in the sacroiliac joints (SIJ) appear only many years after the onset of the disease, the overlying spine areas are involved in the pathological process. Objective: to develop a method for evaluating the radiographic progression of sacroiliitis (SI) in early axSpA for real clinical practice. Subjects and methods. The investigation enrolled patients from the early spondyloarthritis cohort (ESAC) formed at the V.A. Nasonova Research Institute of Rheumatology. The current ESAC comprised 164 patients; the analysis included 68 patients who had been followed up for at least 2 years and had plain pelvic bone films at the inclusion in the cohort and at 2-year follow-up. To evaluate disease progression, the investigators used the sum of radiographic SI stages in the left and right SIJs (the summary stage of radiographic SI (ssrSI), which was calculated at baseline and at 2-year follow-up. A formula for determining the rate of radiographic progression was derived. Results and discussion. At baseline and at 2-year follow-up, the median ssrSI difference (ΔssrSI) in 68 patients was 0 [0; 1.0]. During the study period, almost 60% of the patients had no progression of ssrSI, i.e. ΔssrSI was 0 in these patients, 1 and 2 scores in 12 (18%) and 13 (19%) patients, respectively, and there were singly cases, in which this figure was equal to 3, 4 and 7. The mean value of ssrSI was 3.5±1.6 at baseline and increased by 0.8, reaching 4.3±1.5 at 2 years (p = 0.006). Before included into the investigation, the patients had a progression rate of 1.75 during 1 year, which decreased to 0.4 per year in the active follow-up period. At the time of inclusion in the study, 40 (58.8%) of the 68 patients had ankylosing spondylitis (AS), and at 2 years their number increased to 51 (75.0%); i.e. 11 (39%) patients were observed to have progression of non-radiographic axSpA to AS. Conclusion. The proposed procedure to calculate ssrSI is easily feasible in real practice; it fails to lead to additional radiation exposure, is economically feasible, and allows one to monitor the rate of progression of axSpA in the early stage of the disease.

The relationship between the clinical symptoms and radiography results of patients with isolated blunt elbow trauma

Introduction:Elbow injuries are amongst the most common complaints reported by the adults and children referring to the trauma emergency units and they account for 2% to 3% of the referrals to the emergency units. The majority of these patients are referred to radiography for an examination of fracture, whereas about 30% to 40% of these individuals are found having no clear need for radiography in clinical examinations. The present study aims at investigating the relationship between the clinical and fractures’ examinations scales and their usability for predicting the elbow bone injuries in patients with blunt elbow joint trauma.Patient and Method:The study sample volume included the entire patients with blunt elbow joint trauma who had referred to Hasheminejad and Imam Reza (Peace be upon him) Hospitals during the time span from 2014 to 2015 and also had no past records of elbow joint fracture, surgery and deformity. After performing a preliminary examination of the patients’ elbow joints which was conducted in the form of extension, supination, pronation, topical tenderness evaluations in such regions as ulnar head, radial head and humerus epicondyle as well as investigation for the existence of ecchymosis and hematoma in the elbow joint region, the patients were subjected to standard lateral and anterior-posterior (AP) radiography; the results of the examinations were recorded in a checklist that had been prepared beforehand. Then, the results of the radiographies were studied based on which the proper treatments were figured out. Afterwards, the results of the radiographies were matched with the preliminary examinations and finally they were all exposed to evaluations so as to come up with a conclusion.Results:The study sample volume included 188 patients. Based on the fracture type, the logistic regression analysis data indicated that there is a significant relationship between radial head fracture with restriction in supination of the forearm, sensitivity to palpation on the radius bone head, tenderness to topical touching of the ulnar head bone and sensitivity to topical touch of epicondyle of the humerus and that the former can be applied as a predictor for all of the latter signs (P 0.05). Also, the data analyses showed that there is no significant relationship between the proximal ulnar fracture and any of the clinical signs so the clinical symptoms were found incapable of properly predicting the proximal ulnar fractures (P>0.05).Conclusion:Based on the data analysis, it seems that some of the clinical scales can be used as parts of acceptable instruments for predicting the elbow joint fractures so that the unnecessary diagnostic radiographies could be prevented.

Does the normal four steps weight-bearing rule predict the need for radiography in cases of blunt ankle trauma?

Background: Ankle injuries are one of the most common complaints of patients presenting to emergency departments (ED). The Ottawa ankle rules (OAR) was introduced to help physicians to decide who may require x-ray for blunt injuries. The present study aimed at validating the four steps weight-bearing rule of OAR as a sole criterion. Methods: This prospective observational study was conducted on 214 patients with acute ankle injury who referred to 3 emergency departments over a 7-months period in 2008. Main outcome measures of this survey included the sensitivity, specificity, positive and negative predictive values, and the likelihood ratios (positive and negative) of the four steps weight-bearing rule. Results: In this study, 34 fractures were found among the patients. The decision rule had a sensitivity of 0.88 and specificity of 0.61 in detecting all midfoot and ankle fractures. Application of this rule by emergency medicine residents resulted in a 47% reduction in the use of midfoot and ankle radiography. Conclusion: Applying a four steps weight-bearing rule as a sole criterion to detect ankle fractures is not as accurate and sensitive as OAR. Solitary application of this rule may lead to an increasing number of missed fractures compared with OAR.

PL03: Implementation of the Canadian C-Spine Rule by paramedics: a safety evaluation

Introduction: The Canadian C-Spine Rule (CCR) was validated by emergency physicians and triage nurses to determine the need for radiography in alert and stable Emergency Department trauma patients. It was modified and validated for use by paramedics in 1,949 patients. The prehospital CCR calls for evaluation of active neck rotation if patients have none of 3 high-risk criteria and at least 1 of 4 low-risk criteria. This study evaluated the impact and safety of the implementation of the CCR by paramedics. Methods: This single-centre prospective cohort implementation study took place in Ottawa, Canada. Advanced and primary care paramedics received on-line and in-person training on the CCR, allowing them to use the CCR to evaluate eligible patients and selectively transport them without immobilization. We evaluated all consecutive eligible adult patients (GCS 15, stable vital signs) at risk for neck injury. Paramedics were required to complete a standardized study data form for each eligible patient evaluated. Study staff reviewed paramedic documentation and corresponding hospital records and diagnostic imaging reports. We followed all patients without initial radiologic evaluation for 30 days for referral to our spine service, or subsequent visit with radiologic evaluation. Analyses included sensitivity, specificity, kappa coefficient, t-test, and descriptive statistics with 95% CIs. Results: The 4,034 patients enrolled between Jan. 2011 and Aug. 2015 were: mean age 43 (range 16-99), female 53.3%, motor vehicle collision 51.9%, fall 23.8%, admitted to hospital 7.0%, acute c-spine injury 0.8%, and clinically important c-spine injury (0.3%). The CCR classified patients for 11 important injuries with sensitivity 91% (95% CI 58-100%), and specificity 67% (95% CI 65-68%). Kappa agreement for interpretation of the CCR between paramedics and study investigators was 0.94 (95% CI 0.92-0.95). Paramedics were comfortable or very comfortable using the CCR in 89.8% of cases. Mean scene time was 3 min (15.6%) shorter for those not immobilized (17 min vs. 20 min; p=0.0001). A total of 2,569 (63.7%) immobilizations were safely avoided using the CCR. Conclusion: Paramedics could safely and accurately apply the CCR to low-risk trauma patients. This had a significant impact on scene times and the number of prehospital immobilizations.

Determination of radiography requirement in wrist trauma

ObjectivesThe purpose of this study was to evaluate predetermined physical examination and function tests recommended to identify severe injury among patients presenting with wrist injury to the emergency department and to establish a reliable clinical decision rule capable of determining the need for radiography in wrist injuries. Materials and methodsThis was a multicenter prospective derivation study of wrist injuries. All patients were assessed in terms of mechanism of trauma, inspection findings, heart rate, sensitivity at palpation, presence of pain with active movement, grasp strength, and functional tests using an examination form under main headings. Sensitivity, specificity, and positive and negative predictive values were expressed for each sign and each examination finding. ResultsOne hundred nineteen adult patients were enrolled during the 6-month study period. Fracture was identified in 24.3% (n = 29). Presence of pain on the radial deviation, dorsal flexion, distal radioulnar drawer, and axial compression tests exhibited high sensitivity (82.8%, 89.7%, 82.8%, and 86.2%, respectively) and high negative predictive values (88.6%, 81.3%, 87.5%, and 93.6%, respectively) for wrist fracture. Sensitivity of 96.6% was observed when these 4 tests were evaluated together. ConclusionsThe presence of one of these examination findings increases the likelihood of fracture and is adequate to recommend wrist radiography. In addition, there is a strong possibility of radiography being unnecessary if all 4 test results are negative in patients presenting with wrist injury, potentially preventing many nonessential radiographs being performed.

Extension Test and Ossal Point Tenderness Cannot Accurately Exclude Significant Injury in Acute Elbow Trauma

Elbow injury is a common presentation at the emergency department (ED). There are no guidelines indicating which of these patients require radiography, whereas clinical decision rules for other limb injuries are widely accepted and resulted in less radiography and reduced waiting times. We aim to identify clinical signs that can be usedto predict the need for radiography in elbow injury. A prospective observational study at 2 ED locations in the Netherlands was performed. For every eligible patient with acute elbow injury, elbow extension and addition of point tenderness at the olecranon, epicondyles, and radial head were evaluated for predicting the need for radiography (primary endpoint). A subgroup of patients was assessed by a blinded second investigator to analyze interobserver variability (secondary endpoint). All patients received anterior-posterior and lateral elbow radiographs. Fractures were treated according to current guidelines and patients were followed at outpatient clinics. In total, 587 patients were included. Normal extension was observed in 174 patients (30%). Normal extension predicted absence of a fracture or isolated fat pad with 88% sensitivity and 55% specificity. Five patients with normal extension had a fracture that required surgery. Absence of point tenderness in patients with normal extension was observed in only 24 patients, of whom 3 showed a fracture and 1 required surgery. Addition of point tenderness to the extension test to predict absence of a fracture or isolated fat pad resulted in 98% sensitivity and 11% specificity. Interobserver analysis for extension and palpation of olecranon, epicondyles, and radial head resulted in κ values between 0.6 and 0.7. In contrast with previous studies, ours shows that in acute elbow injury, the extension test alone or in combination with point tenderness assessment does not safely rule out clinically significant injury. Interobserver variability was substantial. We would not recommend the use of the extension test (+/- point tenderness assessment) as a clinical decision rule to guide radiologic diagnostics in acute elbow trauma.

Can the Ottawa and Pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics?

Our aim was to study the role of the Ottawa and Pittsburgh rules to reduce the unnecessary use of radiographs following knee injury. We prospectively reviewed 106 patients who were referred to our clinic over a 3-month period. The Ottawa and Pittsburgh rules were applied to individual patients to evaluate the need for radiography. One hundred and one patients (95%) had radiography of their knee. Five patients (5%) had a fracture of their knee and in all cases, the Ottawa and Pittsburgh knee rules were fulfilled. Using the Ottawa rules, 27 radiographs (25%) could have been avoided without missing a fracture. Using the Pittsburgh rules, 32 radiographs (30%) could have been avoided. The Ottawa and Pittsburgh rules have a high sensitivity for the detection of knee fractures. Their use can aid efficient clinical evaluation without adverse clinical outcome and may reduce healthcare costs.

The baric probe: a novel long-term implantable intracranial pressure monitor with ultrasound-based interrogation

Prompt diagnosis of shunt malfunction is critical in preventing neurological morbidity and death in individuals with hydrocephalus; however, diagnostic methods for this condition remain limited. For several decades, investigators have sought a long-term, implantable intracranial pressure (ICP) monitor to assist in the diagnosis of shunt malfunction, but efforts have been impeded by device complexity, marked measurement drift, and limited instrumentation lifespan. In the current report, the authors introduce an entirely novel, simple, compressible gas design that addresses each of these problems. The device described herein, termed the "baric probe," consists of a subdural fluid bladder and multichannel indicator that monitors the position of an air-fluid interface (AFI). A handheld ultrasound probe is used to interrogate the baric probe in vivo, permitting noninvasive ICP determination. To assess the function of device prototypes, ex vivo experiments were conducted using a water column, and short- and long-term in vivo experiments were performed using a porcine model with concurrent measurements of ICP via a fiberoptic monitor. Following a toe region of approximately 2 cm H(2)O, the baric probe's AFI demonstrated a predictable linear relationship to ICP in both ex vivo and in vivo models. After a 2-week implantation of the device, this linear relationship remained robust and reproducible. Further, changes in ICP were observed with the baric probe, on average, 3 seconds in advance of the fiberoptic ICP monitor reading. The authors demonstrate "proof-of-concept" and feasibility for the baric probe, a long-term implantable ICP monitor designed to facilitate the prompt and accurate diagnosis of shunt malfunction. The baric probe showed a consistent linear relationship between ICP and the device's AFI in ex vivo and short- and long-term in vivo models. With a low per-unit cost, a reduced need for radiography or CT, and an indicator that can be read with a handheld ultrasound probe that interfaces with any smart phone, the baric probe promises to simplify the care of patients with shunt-treated hydrocephalus throughout both the developed and the developing world.

Computer-aided diagnosis (CAD) of the skin disease based on an intelligent classification of sonogram using neural network

Today skin diseases and lesions are the most common diseases that people suffer in different age groups, such as eczema, scalp ringworm, skin fungal, skin cancer of different intensity (basal cell carcinoma and squamous cell carcinoma and melanoma…), diabetic ulcers, and etc. There are different ways to evaluate and diagnose mentioned diseases. For example, most dermatologists prescribe the biopsy to diagnose them. This is a simple method to identify the type of skin disease, but that is an invasive method, and in prolonged time leads to pain and discomfort for patients. Another method that can be used to diagnose is based on non-ionizing radiation such as acoustic or ultrasound waves, which is being investigated in this study. It should be noted that ultrasound imaging is one of the best and useful medical diagnostic tool to scan soft tissue. Therefore, the aim of this study is to diagnose the diseases by studying and analyzing sonography images using intelligent artificial neural network, in order to eliminate any need for radiography and pathobiology process in dermatology. Our main diagnostic tool in this study is a sonography image acquisition system that uses non-ionizing ultrasound waves for skin imaging. Intelligent artificial neural network has been used to study and intelligently classify the skin sonograms. The results of this study show the high capability of this method in diagnosis and classification of the skin diseases.

車椅子上で胸部撮影を行うための補助板の考案

Chest radiography is a widely used X-ray inspection. The numbers of patients who use wheelchairs in everyday life has increased in Japan, and their need for radiography has also increased. A unique supporting pad that enables chest radiography for patients in wheelchairs has been developed. This supporting pad applies the force of the patient's weight and the frictional force to hold a cassette on. Performing chest radiography in the wheelchair using the supporting pad reduces the corporal burden of the patient in the wheelchair and the radiological technologist.

312: Derivation of a Decision Instrument for Selective Chest Radiography In Blunt Trauma

To derive a clinical decision instrument (DI) for selective chest imaging in blunt trauma that identifies patients who have virtually no risk of significant intrathoracic injury (SITI) and therefore no need for radiography. At three Level One trauma centers, physicians caring for blunt trauma patients over age 14 years were asked to record the presence or absence of 12 clinical criteria prior to viewing CXR results. SITI was defined as pneumothorax, hemothorax, aortic/great vessel injury, two or more rib fractures, ruptured diaphragm, sternal fracture and pulmonary contusion on official radiograph readings. Kappa (inter-rater reliability) and screening performance of individual criteria were determined. Using recursive partitioning, the most highly sensitive combination of criteria for SITI was derived as the DI. Of the 2,628 subjects enrolled, 271 (10.3%) were diagnosed with a total of 462 SITIs, with rib fractures (73%), pneumothorax (38%) and pulmonary contusion (29%) as the most common injuries. Chest pain and chest wall tenderness had the highest sensitivity for SITI (65%). The DI of chest pain, distracting injury, chest wall tenderness, intoxication, age > 60, rapid deceleration and altered alertness/mental status had the following screening performance: sensitivity 99.3% (95% CI: 97.4-99.8%), specificity 14.0% (95% CI: 12.6- 15.4%), negative predictive value 99.4% (95% CI: 97.8- 99.8%), and positive predictive value 11.7% (95% CI: 10.5 - 13.1%). All 7 criteria in the DI met the predetermined cut-off for acceptable kappa (range 0.51-0.81). We derived a DI consisting of 7 clinical criteria that can identify SITI in blunt trauma patients with extremely high sensitivity. If validated, this instrument will allow for safe, selective chest imaging with potential resource savings.

Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children

Objective To determine whether full elbow extension as assessed by the elbow extension test can be used in routine clinical practice to rule out bony injury in patients presenting with...