The accuracy of the first chest X-ray in the trauma patient

Chest X-rays (CXR) are important in assessing chest trauma. This study assessed the accuracy of the first CXR in diagnosing moderate to severe chest injuries. One hundred patients presenting during 1985 and identified in the prospective Westmead Trauma Registry as having a chest injury with Abbreviated Injury Scale (AIS) scores of 3 or greater were included (males:females = 4.9:1; age range, 5-74 years). The officially reported interpretations of the first CXR were compared to the chest injuries finally diagnosed. In 19 of 77 survivors and 8 of 17 patients who had a CXR before dying, significant abnormalities (most commonly pneumothorax, haemothorax, spinal and sternal injuries) were not diagnosed on CXR. Although erect CXR with postero-anterior (PA) and lateral projections are said to show accurately most major intrathoracic pathology, CXR of trauma patients are often taken supine, suboptimally, and soon after arrival, whereas chest injury may take time to become apparent. The limitations of mobile CXR must be appreciated, and more formal CXR (antero-posterior and lateral) are advisable at a later stage if the clinical situation permits.