A Decision Rule for Chest Imaging in Blunt Trauma

Chest x-ray is the most common radiographic imaging study performed in patients with acute blunt trauma, but its diagnostic yield for intrathoracic injuries is only 6% to 12%. To develop a clinical decision instrument to identify patients who could forgo chest imaging, researchers prospectively studied patients aged >14 years who presented within 24 hours of blunt trauma and underwent chest x-ray, chest computed tomography, or both in the emergency departments of three level I trauma centers in California between 2007 and 2009. Before viewing images, a trauma attending physician or senior resident recorded the presence or absence of 11 clinical criteria (see the table).

Of 2628 patients, 271 (10.3%) sustained one or more of seven predefined …