Prospective Evaluation of Early Follow-up Chest Radiography after Penetrating Thoracic Injury Regan J. Berg Kenji Inaba Gustavo Recinos Galinos Barmparas Pedro G. Teixeira Chrysanthos Georgiou David Shatz Peter Rhee Demetrios Demetriades

Prospective Evaluation of Early Follow-up Chest Radiography after Penetrating Thoracic Injury
Regan J. Berg Kenji Inaba Gustavo Recinos Galinos Barmparas Pedro G. Teixeira Chrysanthos Georgiou David Shatz Peter Rhee Demetrios Demetriades

Published online: 28 March 2013 Societe Internationale de Chirurgie 2013
Abstract Background In asymptomatic patients with penetrating thoracic trauma and a normal initial chest x-ray successive prospective trials have decreased the minimum observation period required for exclusion of significant injury from 6 to 3 h. Despite the quality of these studies this interval remains arbitrary and the true requisite observation time for safe discharge remains unknown. The current study eval-uates the ability of early repeat chest x-ray at intervals approaching 1 h to exclude clinically significant injury. Methods Eighty-eight asymptomatic patients with pene-trating chest trauma and normal initial chest radiographs were prospectively enrolled in this study. All patients received an early follow-up chest x-ray at a median interval of 1 h and 34 min (interquartile range: 1 h 35 min to 2 h 22 min) and a second repeat x-ray at a delayed interval no earlier than 3 h postadmission. Radiographic abnormalities in clinically stable patients were followed with serial examination and repeat imaging for a minimum of 6 h. All patients received both early and delayed repeat CXRs with no patient discharged before full assessment.
R. J. Berg K. Inaba (2) G. Recinos G. Barmparas P. G. Teixeira C. Georgiou D. Demetriades Division of Trauma and Surgical Critical Care LAC+USC Medical Center 1200 North State Street Inpatient Tower (C)Room C5L100 Los Angeles CA 90033 USA e-mail: kinaba@surgery.usc.edu
D. Shatz Department of Surgery UC Davis Medical Center Sacramento CA USA
P. Rhee Division of Trauma Critical Care and Emergency Surgery The University of Arizona Medical Center Tucson AZ USA
Springer
Results One of the 88 patients with initially normal chest x-ray underwent tube thoracostomy at the discretion of the attending surgeon before any repeat imaging. Of the remaining patients 4 of 87 (4.6 %) demonstrated radio-graphic abnormalities on early repeat imaging. Two patients had pneumothoraces successfully managed with-out intervention; the remaining two demonstrated evidence of hemothorax subsequently undergoing tube thoracos-tomy. Two more patients (2.3 %) developed pneumotho-races on delayed imaging both successfully observed without intervention. Conclusions In asymptomatic patients with penetrating thoracic trauma and normal initial chest radiographs early repeat chest x-ray at intervals approaching 1 h appears sufficient to exclude clinically significant pathol-ogy and to allow safe patient discharge.
Introduction
During the past three decades the management of asymptomatic patients with penetrating torso injury has undergone considerable change shifting from policies of mandatory hospital admission and observation [1 2] to evidence-based strategies of selective emergency depart-ment discharge after repeat interval radiography [3-5]. In 1982 Weigelt et al. [5] reported no significant clinical progression between chest films performed at 6 and 24 h postinjury in 110 asymptomatic patients with thoracic stab wounds. Subsequent replication of these findings prompted wide adoption of a 6-h rule for observation repeat imaging and discharge of stable patients [3]. Need for 6 h observation was initially challenged by retrospective review suggesting equivalency of a 3 h interval for injury exclusion in both blunt and penetrating

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