Thoracic Injury Rule-out Criteria (TIRC) for Predicting Intra-Thoracic Blunt Trauma and the Need for a Chest Radiograph

Description

Forouzanfar et al reported a decision rule (Thoracic Injury Rule-out Criteria, TIRC) to identify a trauma patient at risk for significant intra-thoracic injury. A patient considered to be low risk may not need to have a chest X-ray and thus avoid unnecessary exposure to radiation.

Patient selection: multiple blunt-force trauma

Parameters:

(1) age of the patient

(2) hemodynamic status

(3) Glasgow Coma Score (GCS)

(4) crepitations over chest wall (subcutaneous emphysema)

(5) pulmonary sounds

(6) pain or tenderness in the chest wall

(7) thoracic skin abrasion

(8) dyspnea

Parameter	Finding	Points
age in years	<= 60 years	0
	> 60 years	1
hemodynamic status	stable	0
	instability	1
Glasgow coma score	15	0
	3 to 14	1
crepitations	absent	0
	present	1
pulmonary sounds	normal intensity	0
	decreased	1
pain or tenderness	absent	0
	present	1
thoracic skin abrasion	absent	0
	present	1
dyspnea	absent	0
	present	1

total score =

= SUM(points for all parameters)

Interpretation:

• minimum score: 0

• maximum score: 8

• A patient with none of the risk factors would be considered low risk for intra-thoracic trauma.

Performance:

• Safari et al fount that the rule had an area under the ROC curve of 0.93. The sensitivity was 100% and specificity 68%.

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Thoracic Injury Rule-out Criteria (TIRC) for Predicting Intra-Thoracic Blunt Trauma and the Need for a Chest Radiograph

Description

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