Article including Hoffman shows that 27% of scans deemed unnecessary, but this would have missed 17% of injuries (J Trauma 2009;67:779)
And another where surgery wanted to scan much more than em attendings. There were many missed injuries, but the ED folks in the study did not beleive they were clinically important injuries. (Ann Emerg Med 2011;58:5:407)
One clin prediction rule (Ann Emerg Med 2009;54:575)
have none:GCS<14
costal margin tenderness
abd tenderness
femur fx
hematuria > or equal 25 rbc/hpf
hct<30
pneumo or rib fx on cxr
sens 95.8 (91-98) spec 29.9 (27.5-32.3)
Whole body ct shows survival benefit
And another retrospective study showing the same ( Journal of Trauma and Acute Care Surgery Issue: Volume 75(2), August 2013, p 202–206)
Another article shows in all but the low risk patients, we are not so great at predicting injuries (AJEM 2011;29:1-10)
J Trauma 2011;70(1):174-clinical exam is not sufficient to r/o thoracolumbar spinal fxs if pt not evaluable
CT Scan for Chest Trauma
Results: Sixty-eight patients (73.1%) showed at least one pathologic sign on chest radiograph, and 25 patients (26.9%) had normal chest radiograph. In 13 (52.0%) of these 25 patients, the CT scan showed multiple injuries; among these were two aortic lacerations, three pleural effusions, and one pericardial effusion. Conclusion: Over 50% of patients with normal initial chest radiograph showed multiple injuries on the CT scan, among which were also two (8%) potentially fatal aortic lesions. We therefore recommend primary routine chest CT scan in all patients with major chest trauma. Key Words: Blunt chest trauma, Deceleration trauma, Motor vehicle crash (MVC), Fall from height, Undetected injuries, Aortic lesion, Computed tomographic (CT) scan, Chest radiograph. J Trauma. 2001;51:11731176.
Taking an obvious OR case to CT seems to dramatically increase mortality (The Journal of Trauma: Injury, Infection, and Critical Care Issue: Volume 70(2), February 2011, pp 278-284)
Another UK study showing more injuries found, only small number clin relevant (Emerg Med J 2011;28:378)
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