39 - EFFICACY OF THORACIC COMPUTERIZED AXIAL TOMOGRAPHY IN BLUNT TRAUMA PATIENTS WITH HIGH GLASGOW COMA SCALE AND LOW INJURY SEVERITY SCORE

Objectives: To determine the value of ordering routine chest CT in patients with blunt trauma presented to the Emergency Department (ED) with a high GCS and low ISS , we retrospectively collected data obtained on those patients from the CT scan ,when physical examination and initial chest X- ray were normal in the trauma Bay Area.

Methods: A retrospective data collection of 901 consecutive blunt trauma patients seen in the ED between 2017 and 2019 were analyzed. Data collected included in addition to the physical examination, age, gender, currents use of anticoagulant therapy,
co- morbid conditions as well as result of Radiological Images. In addition while in the hospital length of stay, surgical intervention and mortality. The patients were divided in to two groups: group 1 ( included those patients with negative physical examination, chest X- Ray and CT ) and group 2 ( with negative physical examinations and chest X-Ray and positive CT ) . Statistical analysis was done using Student’s t-test and Chi- square test . IRB approval was obtained prior to conducting the study.

Results: Of the 901 patients there were 489 male and 412 female ( 54% vs 46% ) with the mean age of 56 Years. Out of the 901 patients 461 patients had physical , chest X-ray ,abdominal and chest CT done. Group 1 included 442 (96%), patients ,with negative physical examination, negative chest and CT scan and group 2 , 19 (4%) patients who had positive CT and or chest X- ray . Both groups were similar in GCS and ISS and other variables . Of the 19 patients, only 6 patients had a positive chest CT ,and 3 of those had a positive chest X-ray. In The 3 patients who had negative physical examination and chest X- ray , the CT finding was 1 with undisplaced 10 th rib fractures, and 2 patients with osteoporotic compression fractures of Dorsal vertebrae. Therefore the probability of both chest X-ray and chest CT being positive among group of screened patients is 16% (3/19) ,and probability of a negative chest X- ray but positive CT is 16% (3/19). The Odd Ratio between the two outcomes is 1 ,therefore the CT would not change the clinical management.

Conclusion: In blunt trauma patients presented to the ED with a high GCS and low ISS score, when initial chest physical examination and X-Ray were negative, routine chest CT is of little value.