Utilizing Un-enhanced Chest Computed Tomography Screening for Blunt Trauma Surgery Decisions

Background Blunt chest trauma is a common and potentially life-threatening condition that requires prompt assessment for potential surgical intervention. Computed tomography (CT) of the chest has emerged as a valuable tool due to its heightened sensitivity and specificity in detecting thoracic injuries compared to conventional chest radiography. Objective This study aims to assess the impact of non-contrast CT chest findings on surgical decision-making and compare these findings with those from chest radiographs. Methods The study was conducted at the Accident and Emergency Department of Medical Teaching Institute, Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan. Patients of all ages and genders who presented with blunt chest trauma were included. Non-contrast CT chest scans were used as an initial screening tool and compared with traditional chest radiographs. Data collected included patient demographics, mechanism of injury, diagnostic findings, and treatment decisions. Imaging was performed using a GE Optima 16-slice scanner (Medsystems Sp. z o.o., Lublin, Poland). Results The study included 246 patients, of whom 210 (85.4%) were males. The most common age group was 50 years or older, comprising 71 (28.9%) of the sample. The predominant mechanism of trauma was road traffic accidents, reported by 188 (76.4%) patients. Hemopneumothorax was detected in 121 (49.2%) patients on CT scans compared to 34 (13.8%) patients on chest radiographs. On chest radiograph, the pneumothorax component was missed in 43 (17.5%) patients, and the hemothorax component was not detected in 21 (8.5%) patients. Patient management included conservative management in 30 (12.2%) cases and surgical intervention in the form of unilateral tube thoracostomy in 173 (70.3%) patients or bilateral tube thoracostomy in 43 (17.5%) patients. Conclusion Our study supports the use of non-contrast CT scans as a reliable diagnostic tool for blunt chest trauma, consistent with current literature. This approach facilitates prompt management decisions, particularly for initiating tube thoracostomy based on findings of pneumothorax and hemothorax. The rarity of mediastinal great vessel trauma further justifies minimizing routine contrast use, thereby enhancing the efficiency of trauma evaluations.