Diagnostic accuracy of initial chest x-rays in thorax trauma

Abstract

Objective: To evaluate the efficacy, sensitivity and specificity of chest x-ray as a diagnostic imaging tool in management of thorax traumas.Study Design: Descriptive study.Place and Duration of Study: Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey, between December 2014 and December 2015.Methodology: Case records of patients admitted to the emergency department with thoracic trauma were retrospectively analysed through the hospital database. Plain postero-anterior chest X-rays and thorax computerised tomography (CT) scans were evaluated seperately by same radiologist. Accurcy of signs of thoracic trama was determined using CT scan as gold standard.Results: Nine of 23 pneumothorax patients were diagnosed by chest X-ray. Sensitivity and specificity of PA chest X-ray in the diagnosis of pneumothorax was 39.1% and 100%, respectively. Positive predictive values of chest X-ray for diagnosis of pneumothorax was 100% and negative predictive value was 97.1%. Twenty-four patients had pleural effusions on CT scans, while only 15 could be diagnosed in chest X-rays. Chest X-rays were 62.5% sensitive and 100% specific with positive and negative predictive values of 100% and 98.1%, respectively. Twenty of 41 rib fractures were diagnosed with X-rays. Chest x rays had a 48.8% sensitivity and 100% specificity, and positive and negative predictive values were 100% and 95.6%, respectively.Conclusion: Chest X-ray should not be used as a sole diagnostic imaging tool for exclusion of pneumothorax, hemothorax, and lung contusion. Due to high predictive values of chest X-rays, they can be used for follow-up.