Suspected chest trauma. Initial imaging. CT Chest Noncontrast CT of the chest can detect most injuries, including rib fractures, pneumothorax, hemothorax, and pulmonary contusion, but has a lower sensitivity for detecting vascular injuries [20]. Contrast-enhanced CT of the chest is the preferred imaging workup of suspected chest trauma. Regardless of contrast administration, CT is more sensitive and specific for chest trauma than conventional radiographs [48,49]. Patients who have an abnormal chest radiograph in the setting of trauma have clinically significant rates of major injury on CT chest [8]. CT Whole Body Currently, there is no practice consensus or validated decision rules for deciding which patients should receive WBCT versus selective chest CT imaging for blunt trauma with concern for a chest injury. Some studies have found a survival benefit to WBCT compared with selective CT [14], whereas others have found no mortality benefit [15]. Meta-analyses have found conflicting results with respect to improvements in mortality [16-18]. Therefore, clinical judgement remains vital for determining which patients should obtain selective CT versus WBCT. Indications that may warrant WBCT imaging as defined above include high-velocity (>35 mph) MVC, MVC resulting in rollover or passenger ejection, motorcycle trauma, bicycle injury, MVC-pedestrian collision, and a fall from a height of >15 feet. Additional considerations include patient age and functional status, hemodynamic stability, neurological status, and results of initial imaging from portable radiographs of the chest and pelvis, and/or FAST. CT of the chest, abdomen, and pelvis with IV contrast have greater sensitivity for detecting visceral organ and vascular injury compared with noncontrast CT, and contrast-enhanced CT of these areas should be primarily considered unless absolutely contraindicated [19,20].
Major Blunt Trauma. Suspected chest trauma. Initial imaging. CT Chest Noncontrast CT of the chest can detect most injuries, including rib fractures, pneumothorax, hemothorax, and pulmonary contusion, but has a lower sensitivity for detecting vascular injuries [20]. Contrast-enhanced CT of the chest is the preferred imaging workup of suspected chest trauma. Regardless of contrast administration, CT is more sensitive and specific for chest trauma than conventional radiographs [48,49]. Patients who have an abnormal chest radiograph in the setting of trauma have clinically significant rates of major injury on CT chest [8]. CT Whole Body Currently, there is no practice consensus or validated decision rules for deciding which patients should receive WBCT versus selective chest CT imaging for blunt trauma with concern for a chest injury. Some studies have found a survival benefit to WBCT compared with selective CT [14], whereas others have found no mortality benefit [15]. Meta-analyses have found conflicting results with respect to improvements in mortality [16-18]. Therefore, clinical judgement remains vital for determining which patients should obtain selective CT versus WBCT. Indications that may warrant WBCT imaging as defined above include high-velocity (>35 mph) MVC, MVC resulting in rollover or passenger ejection, motorcycle trauma, bicycle injury, MVC-pedestrian collision, and a fall from a height of >15 feet. Additional considerations include patient age and functional status, hemodynamic stability, neurological status, and results of initial imaging from portable radiographs of the chest and pelvis, and/or FAST. CT of the chest, abdomen, and pelvis with IV contrast have greater sensitivity for detecting visceral organ and vascular injury compared with noncontrast CT, and contrast-enhanced CT of these areas should be primarily considered unless absolutely contraindicated [19,20].