Patient selection: age >= 15 years following blunt trauma
Outcome: detection of significant intrathoracic injury (SITI) that can be detected on a chest X-ray: pneumothorax, hemothorax, aortic/great vessel injury, 2+ rib fractures, ruptured diaphragm, sternal fracture, pulmonary contusion.
A chest X-ray was done if any of the following was present:
(1) chest pain
(2) distracting injury
(3) chest wall tenderness
(4) intoxication
(5) age of the patient > 60 years
(6) rapid deceleration
(7) abnormal mental status (abnormal alterness)
Performance:
• The negative predictive value was 99.4% while the positive predictive value was 12% (462 SITI were identified in the 2,297 patients who had chest X-rays performed).
Limitations:
• Only about 8% of patients were considered low risk.
• It is not applicable to children or young adolescents.
• The endpoint was detection of intrathoracic injury detectable by a chest X-ray.
• The rule does not exclude extra-thoracic injury or the need to use other imaging methods to detect intra-thoracic injury when indicated.
• Injuries that could be present in a patient labeled low risk include: pericardial tamponade, cardiac contusion, isolated rib fracture, fracture of clavicles, injury to shoulder or neck.
