Two Decision Instruments ID Major Injuries in Blunt Trauma

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Two DIs have high sensitivity for identifying blunt trauma patients with clinically significant thoracic injuries.
Two DIs have high sensitivity for identifying blunt trauma patients with clinically significant thoracic injuries.

HealthDay News -- Two decision instruments (DIs) have high sensitivity for identifying blunt trauma patients with clinically significant thoracic injuries, according to a study published in PLOS Medicine.

Robert M. Rodriguez, MD, from the University of California in San Francisco, and colleagues prospectively derived and validated two DIs for selective chest computed tomography (CT) in adult blunt trauma patients presenting to eight U.S. urban level-1 trauma centers. A total of 6,002 patients were enrolled in the derivation phase and 5,475 in the validation phase. The derived Chest CT-All DI included abnormal chest X-ray; rapid deceleration mechanism; distracting injury; and chest wall, sternal, thoracic spine, and scapular tenderness. The same criteria were used for the Chest CT-Major DI, without the rapid deceleration mechanism.

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The researchers found that the sensitivity, specificity, and negative prediction values were 99.2, 20.8, and 99.8 percent, respectively, for major injury with the Chest CT-All DI; the corresponding values were 95.4, 25.5, and 93.9 percent for either minor or major injury. Sensitivity, specificity, and negative predictive values were 99.2, 31.7, and 99.9, respectively, for major injury, and 90.7, 37.9, and 91.8 percent, respectively, for either major or minor injury with the Chest-CT-Major.

"Trauma evaluation protocols that incorporate these DIs may decrease unnecessary costs and radiation exposure in the disproportionately young trauma population," the authors wrote.

Reference

  1. Rodriguez R, Langdorf M, Nishijima D et al. Derivation and Validation of Two Decision Instruments for Selective Chest CT in Blunt Trauma: A Multicenter Prospective Observational Study (NEXUS Chest CT). PLoS Med. 2015;12(10):e1001883. doi:10.1371/journal.pmed.1001883.
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