Rodriguez et al developed a decision rule for identifying a subset of patients who may not require a chest X-ray following blunt trauma. The rule can reduce the number of unnecessary chest X-rays performed but the user must be aware of its limitations. The authors are from the University of California San Francisco, University of California Fresno, and the University of California at Los Angeles.


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)



• 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).



• 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.


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