Complementary exams in blunt torso trauma. Perform only radiographs and fast: is it safe?

ABSTRACTObjective:to evaluate effectiveness of using chest X-ray (CXR), pelvis X-ray (RXP) and FAST (Focused Abdominal Sonography on Trauma) to exclude significant lesions of the body in blunt trauma.Methods:a prospective study involving 74 patients whom made the three tests (CXR, RXP and FAST) during the initial evaluation between October 2013 and February 2014. The results were compared to the tomography of the same patients or clinical outcome. If the patient did not have alterations on the CT scans or during the observation time, the initial workup was considered safe. All patients were evaluated at the Hospital João XXIII, Belo Horizonte, Brazil.Results:of the 74 patients studied the average age was 33 years, RTS: 6.98, ECG: 12. From 44 (59.45%) patients with exams (radiographs and FAST) unchanged, three had significant injuries (two splenic injuries and one liver injury) diagnosed by clinical monitoring. The remaining patients - 30 (40.55%) - had at least one alteration in conventional tests. Of these group 27 (90%) had significant injuries and three (10%) minor injuries. The sensitivity of all three tests for screening considerable lesions was 90% and the specificity was 93%. The negative predictive value was 93% and the positive predictive value 89%.Conclusion:this research showed that all the three exams - chest X-ray, pelvis and FAST - are safe to lead with the blunt trauma if well used and associated with clinical examination.

摘要
目的：评估采用胸部X线摄影（Chest X-ray, CXR）、骨盆X线摄影（Pelvis X-ray, RXP）以及创伤重点腹部超声检查（Focused Abdominal Sonography on Trauma, FAST）排查钝性创伤患者全身显著损伤的有效性。
方法：本研究为前瞻性研究，纳入2013年10月至2014年2月期间在初始评估阶段完成上述三项检查的74例患者。将检查结果与同一患者的计算机断层扫描（CT）结果或临床转归进行对比；若患者的CT扫描未见异常且观察期内无异常表现，则判定初始评估方案安全可靠。所有患者均在巴西贝洛奥里藏特的若昂XXIII医院接受评估。
结果：本研究纳入的74例患者平均年龄为33岁，创伤评分（RTS）为6.98，心电图（ECG）评分为12。其中44例（59.45%）患者的影像学检查及超声检查结果无异常，但其中3例经临床监测确诊存在显著损伤（2例脾脏损伤、1例肝脏损伤）。剩余30例（40.55%）患者的常规检查至少存在1项异常：该组中27例（90%）确诊存在显著损伤，3例（10%）仅存在轻微损伤。三项检查联合筛查显著损伤的灵敏度为90%，特异度为93%；阴性预测值为93%，阳性预测值为89%。
结论：本研究表明，若规范应用并联合临床查体，胸部X线摄影、骨盆X线摄影及创伤重点腹部超声检查这三项检查用于钝性创伤患者的评估均安全可靠。