Ong David, Cheung Michael, Cuenca Peter, Schauer Steven
From the San Antonio Military Medical Center, Fort Sam Houston, the William Beaumont Army Medical Center, Fort Bliss, the Army Medical Department (AMEDD) Center and School, Fort Sam Houston, and the US Army Institute for Surgical Research, San Antonio, Texas.
South Med J. 2019 Jan;112(1):55-59. doi: 10.14423/SMJ.0000000000000921.
The Advanced Trauma Life Support (ATLS) course encourages the use of chest x-ray (CXR) to identify injuries that may change clinical management during the initial stage of trauma resuscitations. Several studies have failed to show benefit for the routine use of CXR without a clinical indication, however. We sought to validate these findings by determining the incidence of clinically significant findings discovered on a portable single-view CXR during the initial stabilization of trauma patients at a Level 1 trauma center.
Using our electronic medical record system, we searched for all of the patients who were brought in as a trauma activation that had a portable single-view CXR performed in the emergency department. We used a selected sampling of available subjects for inclusion into the study. We reviewed the staff radiologist reports for positive findings and reviewed the physician and nursing flow sheets for procedural interventions occurring after the CXR was performed but before leaving the resuscitation area. Subjects who were transferred from another facility, had a thoracic procedure performed before CXR or underwent computed tomography before CXRs were excluded.
From 2011 through 2012, we found 2101 subjects who had a portable CXR performed in the emergency department. We reviewed the first 400 subjects' records, with 33 (8.3%) subjects having positive findings on CXR. Of those 33, 8 met inclusion criteria and the remainder met exclusion criteria. The most common findings were pneumothorax (n = 4), clavicle fracture (n = 3), and rib fracture (n = 2). No subjects received a procedural intervention before leaving the resuscitation bay to be transported to the operating room or the computed tomography suite.
We observed a low incidence of abnormal findings on portable CXR during the initial stabilization of trauma patients, none of whom received an immediate procedural intervention. This dataset supports previously published reports that suggest that a more targeted approach to CXR use may reduce resource utilization.
高级创伤生命支持（ATLS）课程鼓励在创伤复苏初期使用胸部X光片（CXR）来识别可能改变临床治疗的损伤情况。然而，多项研究未能证明在无临床指征时常规使用CXR有何益处。我们试图通过确定在一级创伤中心对创伤患者进行初始稳定治疗期间，便携式单视图CXR上发现的具有临床意义的发现的发生率，来验证这些研究结果。
利用我们的电子病历系统，我们搜索了所有因创伤激活而被送入急诊科并进行了便携式单视图CXR检查的患者。我们对可用受试者进行了抽样选择以纳入研究。我们查看了放射科工作人员报告中的阳性发现，并查看了医生和护理流程表，以了解在CXR检查后但在离开复苏区之前进行的程序干预情况。从其他机构转来的、在CXR检查前进行过胸部手术或在CXR检查前接受过计算机断层扫描的受试者被排除在外。
2011年至2012年期间，我们发现有2101名受试者在急诊科进行了便携式CXR检查。我们查看了前400名受试者的记录，其中33名（8.3%）受试者的CXR检查有阳性发现。在这33名受试者中，8名符合纳入标准，其余符合排除标准。最常见的发现是气胸（n = 4）、锁骨骨折（n = 3）和肋骨骨折（n = 2）。在离开复苏区被送往手术室或计算机断层扫描室之前，没有受试者接受程序干预。
我们观察到在创伤患者初始稳定治疗期间，便携式CXR检查发现异常的发生率较低，且没有患者接受立即的程序干预。该数据集支持了先前发表的报告，这些报告表明采用更有针对性的CXR使用方法可能会减少资源利用。
