Patient selection: age < 16 years, with blunt torso trauma
Thoracic injuries: pulmonary contusion, hemothorax, pneumothorax, pneumomediastinum, tracheal-bronchial disruption, aortic injury, hemopericardium, pneumopericardium, cardiac contusion, rib fracture, sternal fracture, injury to the diaphragm
Predictors from multiple logistic regression:
(1) low systolic blood pressure (adjusted odds ratio 4.6)
(2) elevated age-adjusted respiratory rate (adjusted odds ratio 2.9)
(3) abnormal findings on the examination of the thorax (adjusted odds ratio 3.6)
(4) abnormal chest auscultation (adjusted odds ratio 8.6)
(5) femur fracture (adjusted odds ratio 2.2)
(6) Glasgow coma scale < 15 (adjusted odds ratio 3.3)
98% of patients with thoracic injuries had at least 1 of these findings.
2% of patients with thoracic injury had 0 findings but these did not require an intervention. These patients represented 0.6% of those with no findings.
A patient with no findings probably does not need imaging studies.
