Table 2.
Definitions of composite predictors of chest injuries on CT
| Composite predictor | Definition: predictors were positive if any of the following conditions were fulfilled | References |
|---|---|---|
| ≥55 years | –Age 55 years or older | [28] |
| Dangerous mechanism of injury | Motor vehicle collision and any of the following: | [20, 21, 29–32] |
| –No use of constraints | ||
| –Ejection from the vehicle | ||
| –Death occupant | ||
| PEb chest | –Breathing frequency <10/min or >29/min (pre-hospital or on presentation at the EDa) | [20–23, 33–40] |
| –Pulse oximetry SaO2 <95% at presentation at the ED | ||
| –Decreased breathing sounds at auscultation | ||
| –Subcutaneous emphysema at palpation | ||
| –Tenderness to palpation of the chest wall | ||
| –Lacerations or haematoma of the chest wall | ||
| PE circulatory problems | –Systolic blood pressure <90 mmHg (pre-hospital or at presentation at the ED) | [20–22, 28, 41] |
| –Heart rate >120 beats per minute (pre-hospital or at presentation at the ED) | ||
| PE altered sensorium | –Glasgow coma scale <14 on initial presentation at the ED | [14, 22, 24, 40, 42] |
| –Orotracheal intubation before clinical evaluation at the ED | ||
| –Clinical suspicion of drugs or alcohol intoxication | ||
| PE supraclavicular injury | –Any fracture, laceration or haematoma above the clavicle, including the face | [20, 21] |
| PE thoracic spine | –Tenderness to palpation of the midline of the thoracic spine | [14, 32, 42] |
| –Thoracolumbar lacerations or haematoma | ||
| –Neurological deficit suggesting spinal cord injury | ||
| PE abdomen | –Tenderness to palpation | |
| –Lacerations or haematoma | ||
| –Abdominal distension or guarding | ||
| PE extremity fracture | –Clinical suspicion of fractures of the upper or lower extremities, if CR of the extremities were obtained | [20–22, 43, 44] |
| CRc chest | Any of the following abnormalities identified on CR of the chest | [2, 20, 21, 38, 41, 43, 45, 46] |
| –Pulmonary contusion | ||
| –Haemothorax | ||
| –Pneumothorax | ||
| –Subcutaneous emphysema | ||
| –Abnormal mediastinum suggesting aortic injury | ||
| –Spinal fracture | ||
| –Diaphragmatic rupture | ||
| –Rib fractures | ||
| –Scapular fracture | ||
| –Clavicular fracture | ||
| CR thoracic spine | Any of the following abnormalities on CR of the thoracic spine: | [47] |
| –Any fracture of the vertebral body or spinous or transverse processes | ||
| –Spinal malalignment | ||
| CR lumbar spine | Any of the following abnormalities on CR of the lumbar spine: | [20, 47] |
| –Any fracture of the vertebral body or spinous or transverse processes | ||
| –Spinal malalignment | ||
| CR pelvis and abdominal ultrasonography | Any of the following pelvic fractures on CR: | [20, 21, 37] |
| –Pubic bone fracture | ||
| –Fracture acetabulum | ||
| –Fracture illiac wing | ||
| –Luxation sacro-iliac joint | ||
| –Fracture sacrum | ||
| –Femoral head fracture | ||
| –Symphysiolysis | ||
| –Luxation hip | ||
| Abnormal abdominal ultrasound: | ||
| –Presence of free fluid | ||
| BE <−3 | –Arterial blood gas base excess less than −3 mmol/l in initial blood gas samples | |
| Hb <6 | –Blood plasma haemoglobin concentration less than 6 mmol/l |
Note: a ED, emergency department; b PE, physical examination; c CR, conventional radiography