Clinical Utility of Routine Chest X-Rays During the Initial Stabilization of Trauma Patients

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.