Initial diagnosis of therapeutically relevant thoracic lesions in poly-traumatised patients

Purpose: To determine the value of supine chest radiography in comparison to orientating chest CT in the initial diagnostic evaluation of severely polytraumatised patients. Material and methods: 303 patients with primary indication for a cranial CT following trauma were investigated between 1988 and 1993. After performing the cranial CT all patients underwent a chest CT with an average of 6 CT slices without changing the position of the patient and with a median scan time of 4 minutes. The results of the chest CT were correlated with the findings of the supine chest radiography in regard to therapeutically relevant pathological changes. Results: The sensitivity in detection of pneumothorax in supine chest radiography was 53 % versus 97 % in CT, atelectasis 20 % versus 94 %, lung contusion 79 % versus 99 %, haemotothorax 62 % versus 97 %. More fractures were found conventionally (sensitivity 94%) than by chest CT (sensitivity 44 %). Conclusion: Supine chest radiography of polytraumatised patients is clearly inferior to orientating chest CT in demonstrating posttraumatic lesions; obtaining therapeutically relevant information justifies the additionally needed small amount of time.