J. Zhao1, W. A. Guo1 1State University Of New York At Buffalo,Buffalo, NY, USA
Introduction: Limited evidence and lack of expert consensus exist to guide clinicians on how to best image patients following chest trauma. This study aimed to compare outcomes for patients of similar trauma severity who underwent chest X-ray (CXR) versus chest computerized tomography (CCT).
Methods: The 2014 National Trauma Data Bank from the American College of Surgeons Trauma Quality Improvement Program (TQIP) was used for analysis. Only patients whose CXR or CCT took place within the first 24 hours of presentation were studied. Patients were stratified into two groups: those with CCT scans (standalone CCT +/- CXR) versus those only with CXR. Patients were further stratified by injury severity scores (ISS), revised trauma scores (RTS), and thorax-specific abbreviated injury scale (AIS). Hospital length of stay (LOS), mechanical ventilation (MV) and intensive care (ICU) need and duration, and mortality were calculated for each scoring stratification.
Results: A total of 45,165 (80%) patients underwent CCT, while 11,180 (20%) patients had CXR only. A higher percentage of patients who underwent CCT required ICU admission and MV (p<0.01). CCT patients required a longer hospital/ICU LOS, and MV duration compared to the CXR group. However, CCT was associated with lower mortality based on ISS and RTS, but not on AIS, than CXR alone (Figure 1).
Conclusion: Analysis of TQIP data showed that CCT, when undertaken within the first 24 hours of trauma presentation, was linked to longer hospitalizations, ICU LOS, and MV duration than CXR. However, these increases in hospital resource utilization appeared justified by the survival benefit associated with CCT.
