• Cristobal Barrios, Jacqueline Pham, Darren Malinoski, Matthew Dolich, Michael Lekawa, and Marianne Cinat.
• Division of Trauma, Critical Care, Burn and Acute Care Surgery, Department of Surgery, University of California Irvine Medical Center, CA, USA. cbarrios@uci.edu
• Am. J. Surg. 2010 Dec 1;200(6):741-4; discussion 744-5.

ObjectiveOur objective was to show that a chest X-ray (CXR) and an abdominal computed tomography (CT) scan are sufficient to identify most clinically significant thoracic injuries in trauma patients, rendering the thoracic CT scan useful in only a subset of patients.MethodsA retrospective study identified thoracic injuries in 374 trauma patients evaluated with a CXR, a thoracic CT scan, and an abdominal CT scan. Injuries seen on the initial CXR versus those seen on a CT scan only (occult) were identified and assessed for clinical relevance.ResultsAn abdominal CT scan identified 65% (15/23) of occult pneumothoraces, 100% (25/25) of occult hemothoraces, 64% (18/28) of occult pulmonary contusions, and 58% (18/31) of occult rib fractures. No occult pneumothoraces seen on the thoracic CT scan alone required tube thoracostomy.ConclusionsOur pilot study suggests that a CXR and an abdominal CT scan will identify most occult intrathoracic injuries. Reserving a thoracic CT scan for patients with an abnormal CXR or high-risk mechanism could safely reduce cost and radiation exposure while still diagnosing significant thoracic injuries.Copyright © 2010 Elsevier Inc. All rights reserved.

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