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<< Emergency Department Evaluation And Management Of Blunt Chest And Lung Trauma (Trauma CME)

Controversies

Thoracic Imaging In Blunt Trauma

Imaging of the injured patient remains controversial. A prospective study published in 2011 showed significant disagreement regarding which imaging studies trauma and emergency physicians thought were appropriate for specific patients.129 In this study, 324 CT chest studies were done. Of these, 40% were desired by the trauma surgeon only (ie, the most senior emergency medicine physician treating the patient did not think a CT was indicated) and 23% percent of the undesired scans had abnormalities on CT. While emergency physicians in this study would have missed a large number of injuries, most of the injuries did not have clinical significance. Management decisions remain a complicated process, and the desire to diagnose injuries that are not clinically significant must be balanced with potential harms, including resource utilization, ionizing radiation exposure, risk of contrast reactions, and potential false-positive findings. 

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