Assessment of Chest CT Scan Findings in Multiple Trauma Patients Admitted to the Emergency Department of Khatam-al-Anbia Hospital in Zahedan in 2023
Abstract
Background: This study investigates the clinical predictors of chest CT scan findings in patients with chest
trauma presenting to the emergency department of Khatam-Al-Anbia Hospital in Zahedan in 2023.
Methods: A cross-sectional study was conducted on 460 patients with multiple traumas. Data were collected from CT scan reports and analyzed using SPSS 22 software, employing independent t-tests, correlation coefficients,and chi-square tests.
Results:The mean age of the patients was 40.2 ± 20.36 years (range: 16–97). Gender distribution included 28.7%
women and 71.3% men. Significant differences in CT scan findings were observed based on gender (P = 0.032),
trauma mechanism (P = 0.029), and clinical complaint type (P = 0.017). Patients under 20 years old exhibited
more normal findings, whereas those over 40 had a higher prevalence of rib and thoracic vertebra fractures.
Traffic accidents and collisions frequently resulted in rib and thoracic vertebra fractures, while altercations were
more commonly associated with pneumothorax. Clinical complaints of chest pain and deformity were frequently linked to pneumothorax and rib fractures.
Conclusions: These findings underscore the importance of age, trauma mechanism, and clinical complaints in
diagnosing chest trauma, facilitating more informed decision-making and diagnosis.
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5. Salimi J, Khaji A. Trauma mortality in six university hospitals: Tehran, Iran. Tehran Univ Med J. 2007;65(Suppl 2):225.
6. Haagsma JA, Graetz N, Bolliger I, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease Study
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7. Fazel MR, Fakharian E, Mahdian M, et al. Demographic profiles of adult trauma during a five-year period (2007- 2011) in Kashan, IR Iran. Arch Trauma Res. 2012;1(2):63.
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8. Lyn-Sue J, Siram S, Williams D, Mezghebe H. Epidemiology of trauma deaths in an urban level-1 trauma center predominantly among African Americans-implications for prevention. J Natl Med Assoc. 2006;98(12):1940.
9. Mohta M, Kumar P, Mohta A, et al. Experiences with chest trauma: where do we stand today. Indian J Crit Care Med. 2006;10(1):258. https://doi.org/10.4103/0972-5229.24686
10. Saho EY. Blunt chest trauma. PCCU. 2004;15(18).Available at: [URL].
11. Zargar M, Zafarghandi M, Mdaghgh H, et al. Significance of trauma mechanism and its effect on the outcome of trauma patients. Tehran Univ Med J. 1998;56(5):101-8.
12. Hill A, Fowler R, Pinto R, Nathens A. Epidemiology of major trauma: a Canadian perspective. Can J Surg. 2011;54(3).
13. Søreide K. Epidemiology of major trauma. Br J Surg. 2009;96(7):69-78. https://doi.org/10.1002/bjs.6643
14. Mohta M, Kumar P, Mohta A, et al. Experiences with chest trauma: where do we stand today. Indian J Crit Care Med. 2006;10(1):25-8. https://doi.org/10.4103/0972-
5229.24686
15. Adebonojo SA. Management of chest trauma: a review. West Afr J Med. 1993;12:122-32.
16. Adnet F, Lapandry C, Lapostolle F. Thoracic trauma. Rev Prat. 2003;53:967-74.
17. LoCicero J 3rd, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am. 1989;69:15-9. https://doi. org/10.1016/S0039-6109(16)44730-4
18. Liman ST, Kuzucu A, Tastepe AI. Chest injury due to blunt trauma. Eur J Cardiothorac Surg. 2003;23:374-8. https://doi.org/10.1016/s1010-7940(02)00813-8
19. Rodriguez RM, Hendey GW, Marek G. A pilot study to derive clinical variables for selective chest radiography in blunt trauma patients. Ann Emerg Med. 2006;47:415-8.
https://doi.org/10.1016/j.annemergmed.2005.10.001
20. Ton MB, Reginaldy F, Moore EE, Schwarts T. Textbook of principles of surgery. Vol 11. 7th ed. 1998. pp. 311-2.
21. Shields TW, Locicero SL. Chest trauma: general thoracic surgery. Vol 19. 5th ed. Philadelphia: 1998. pp. 115-6.
22. Rangraz Jeddi F, Farzandipour M. Epidemiology of trauma in patients hospitalized in Naghavi Hospital, Kashan, 2000. Feyz. 2002;6(2):88-93.
23. Fitzharris M, Franklyn M, Frampton R. Thoracic aortic injury in motor vehicle crashes: the effect of impact direction, side of body struck, and seat belt use. J
Trauma. 2004;57:582-90. https://doi.org/10.1097/01.TA.0000088015.83951.D0
24. Yamamoto L, Schroeder C, Morley D, Beliveau C. Thoracic trauma: the deadly dozen. Crit Care Nurs Q. 2005;28:22-40. https://doi.org/10.1097/00002727-200501000-00004
25. Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, et al. Application of ultrasonography and radiography in detection of hemothorax: a systematic review and metaanalysis. Emerg. 2016;4(3):116.
26. Brenner DJ. Medical imaging in the 21st century: getting the best bang for the rad. Mass Med Soc. 2010. https://doi.org/10.1056/NEJMe1000802
27. Brenner DJ, Hall EJ. Computed tomography-anincreasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-84. https://doi.org/10.1056/NEJMra072149
28. Lee J, Kirschner J, Pawa S, et al. Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007. Ann Emerg
Med. 2010;56(6):5916.e1. https://doi.org/10.1016/j.annemergmed.2010.05.027
29. Chardoli M, Hasan-Ghaliaee T, Akbari H. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma.
Chin J Traumatol. 2013;16:351-4.
30. Brink M, Deunk J, Dekker HM. Added value of routine chest MDCT after blunt trauma: evaluation of additional findings and impact on patient management. AJR Am J
Roentgenol. 2008;190:1591-8. https://doi.org/10.2214/AJR.07.3277
31. Barrios C, Malinoski D, Dolich M. Utility of thoracic computed tomography after blunt trauma: when is chest radiograph enough? Am Surg. 2009;75:966-9. https://doi.
org/10.1177/000313480907501023
32. Pouragaei M, Montazer M, Moharramzadeh P, et al. Chest CT findings in patients with chest trauma referred to TabrizImam Reza Hospital in 2015: a short report. Iran J Emerg
Med. 8(1):1-10.
33. Safari S, Farbod M, Hatamabadi H, et al. Clinical predictors of abnormal chest CT scan findings followingblunt chest trauma: a cross-sectional study. Chin J Traumatol. 2020;23(1):51-5. https://doi.org/10.1016/j.cjtee.2019.07.007
34. Çorbacıoğlu SK, Er E, Aslan S, et al. The significance of routine thoracic computed tomography in patients with blunt chest trauma. Injury. 2015;46(5):849-53. https://doi.org/10.1016/j.injury.2014.12.022
35. Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging. 2011;2(3):281-95. https://doi. org/10.1007/s13244-011-0072-9
36. Rasooli F, Safaie A, Abdollahi A. Management of penetrating thoracic injury due to foreign body: a case report. Iran J Emerg Med. 2020;6(1):159-61.
37. Hu H. Multi-slice helical CT: scan and reconstruction. Med Phys. 1999;26(1):5-18. https://doi.org/10.1118/1.598470
38. Shah V, Keniya R, Shridharani A, et al. Diagnosis of COVID-19 using CT scan images and deep learning techniques. Emerg Radiol. 2021;28:497-505. https://doi.org/10.1007/s10140-020-01886-y
39. Riquelme D, Akhloufi MA. Deep learning for lung cancer nodules detection and classification in CT scans. AI.2020;1(1):28-67. https://doi.org/10.3390/ai1010003
40. Manoharan DS, Sathesh A. Early diagnosis of lung cancer with probability of malignancy calculation and automatic segmentation of lung CT scan images. J Innov Image Process. 2020;2(4):175-86. https://doi.org/10.36548/jiip.2020.4.002
41. Spinazzola J, Van der Kolk B, Ford JD. Developmental trauma disorder: a legacy of attachment trauma in victimized children. J Trauma Stress. 2021;34(4):711-20.https://doi.org/10.1002/jts.22697
42. Ley EJ, Brown CV, Moore EE, et al. Updated guidelines to reduce venous thromboembolism in trauma patients: a Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2020;89(5):971. https://doi.org/10.1097/TA.0000000000002830
43. Rodney T, Taylor P, Dunbar K, et al. High IL-6 in military personnel relates to multiple traumatic brain injuries and post-traumatic stress disorder. Behav Brain Res. 2020;392:112715. https://doi.org/10.1016/j.bbr.2020.112715
44. Hessami MA, Fakhri M. The study of patients with thorax injury in Kermanshah trauma center. Behbood. 2016;12(2):170-9.
45. Rezaeenasab M, et al. A six-month study of injured patients with chest trauma referred to Ali Ibn Abi Talib Medical Training Center. J Rafsanjan Univ Med Sci. 2016;4(4):242-7.
46. Parag P, Hardcastle TC. Interpretation of emergency CT scans in polytrauma: trauma surgeon vs radiologist. AfrJ Emerg Med. 2020;10(2):90-4. https://doi.org/10.1016/j.afjem.2020.01.008
47. Çelik A, Akoglu H, Omercikoglu S, et al. The diagnostic accuracy of ultrasonography for the diagnosis of rib fractures in patients presenting to emergency department with blunt chest trauma. J Emerg Med. 2021;60(1):90-7.
https://doi.org/10.1016/j.jemermed.2020.06.063
48. Abdolrahimzadeh Fard H, Mahmudi-Azer S, Sefidbakht S, et al. Evaluation of chest CT scan as a screening and diagnostic tool in trauma patients with COVID-19: a crosssectionalstudy. Emerg Med Int. 2021;2021. https://doi.org/10.1155/2021/4188178
49. Hu J, Zheng ZF, Wang SH, et al. Missed rib fractures on initial chest CT in trauma patients: time patterns, clinical and forensic significance. Eur Radiol. 2021;31:2332-9. https://doi.org/10.1007/s00330-020-07310-w
2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden
of Disease Study 2010. Lancet. 2012;380(9859):2095-128.https://doi.org/10.1016/S0140-6736(12)61728-0
3. Faridaalaee G, Latifi A, Peyvandi R, et al. Factors related to car accidents in Maragheh-Hashtrood road: a crosssectional study. Iran J Emerg Med. 2020;7(1):e7e.
4. Ahmadi M. Visual impairment among the out-of-town driving in Chaharmahal and Bakhtiari province 1378. J Univ Med Sci. 1380;3(3):18-23.
5. Salimi J, Khaji A. Trauma mortality in six university hospitals: Tehran, Iran. Tehran Univ Med J. 2007;65(Suppl 2):225.
6. Haagsma JA, Graetz N, Bolliger I, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease Study
2013. Inj Prev. 2016;22(1):3-18. https://doi.org/10.1136/injuryprev-2015-041616
7. Fazel MR, Fakharian E, Mahdian M, et al. Demographic profiles of adult trauma during a five-year period (2007- 2011) in Kashan, IR Iran. Arch Trauma Res. 2012;1(2):63.
https://doi.org/10.5812/atr.6770
8. Lyn-Sue J, Siram S, Williams D, Mezghebe H. Epidemiology of trauma deaths in an urban level-1 trauma center predominantly among African Americans-implications for prevention. J Natl Med Assoc. 2006;98(12):1940.
9. Mohta M, Kumar P, Mohta A, et al. Experiences with chest trauma: where do we stand today. Indian J Crit Care Med. 2006;10(1):258. https://doi.org/10.4103/0972-5229.24686
10. Saho EY. Blunt chest trauma. PCCU. 2004;15(18).Available at: [URL].
11. Zargar M, Zafarghandi M, Mdaghgh H, et al. Significance of trauma mechanism and its effect on the outcome of trauma patients. Tehran Univ Med J. 1998;56(5):101-8.
12. Hill A, Fowler R, Pinto R, Nathens A. Epidemiology of major trauma: a Canadian perspective. Can J Surg. 2011;54(3).
13. Søreide K. Epidemiology of major trauma. Br J Surg. 2009;96(7):69-78. https://doi.org/10.1002/bjs.6643
14. Mohta M, Kumar P, Mohta A, et al. Experiences with chest trauma: where do we stand today. Indian J Crit Care Med. 2006;10(1):25-8. https://doi.org/10.4103/0972-
5229.24686
15. Adebonojo SA. Management of chest trauma: a review. West Afr J Med. 1993;12:122-32.
16. Adnet F, Lapandry C, Lapostolle F. Thoracic trauma. Rev Prat. 2003;53:967-74.
17. LoCicero J 3rd, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am. 1989;69:15-9. https://doi. org/10.1016/S0039-6109(16)44730-4
18. Liman ST, Kuzucu A, Tastepe AI. Chest injury due to blunt trauma. Eur J Cardiothorac Surg. 2003;23:374-8. https://doi.org/10.1016/s1010-7940(02)00813-8
19. Rodriguez RM, Hendey GW, Marek G. A pilot study to derive clinical variables for selective chest radiography in blunt trauma patients. Ann Emerg Med. 2006;47:415-8.
https://doi.org/10.1016/j.annemergmed.2005.10.001
20. Ton MB, Reginaldy F, Moore EE, Schwarts T. Textbook of principles of surgery. Vol 11. 7th ed. 1998. pp. 311-2.
21. Shields TW, Locicero SL. Chest trauma: general thoracic surgery. Vol 19. 5th ed. Philadelphia: 1998. pp. 115-6.
22. Rangraz Jeddi F, Farzandipour M. Epidemiology of trauma in patients hospitalized in Naghavi Hospital, Kashan, 2000. Feyz. 2002;6(2):88-93.
23. Fitzharris M, Franklyn M, Frampton R. Thoracic aortic injury in motor vehicle crashes: the effect of impact direction, side of body struck, and seat belt use. J
Trauma. 2004;57:582-90. https://doi.org/10.1097/01.TA.0000088015.83951.D0
24. Yamamoto L, Schroeder C, Morley D, Beliveau C. Thoracic trauma: the deadly dozen. Crit Care Nurs Q. 2005;28:22-40. https://doi.org/10.1097/00002727-200501000-00004
25. Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, et al. Application of ultrasonography and radiography in detection of hemothorax: a systematic review and metaanalysis. Emerg. 2016;4(3):116.
26. Brenner DJ. Medical imaging in the 21st century: getting the best bang for the rad. Mass Med Soc. 2010. https://doi.org/10.1056/NEJMe1000802
27. Brenner DJ, Hall EJ. Computed tomography-anincreasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-84. https://doi.org/10.1056/NEJMra072149
28. Lee J, Kirschner J, Pawa S, et al. Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007. Ann Emerg
Med. 2010;56(6):5916.e1. https://doi.org/10.1016/j.annemergmed.2010.05.027
29. Chardoli M, Hasan-Ghaliaee T, Akbari H. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma.
Chin J Traumatol. 2013;16:351-4.
30. Brink M, Deunk J, Dekker HM. Added value of routine chest MDCT after blunt trauma: evaluation of additional findings and impact on patient management. AJR Am J
Roentgenol. 2008;190:1591-8. https://doi.org/10.2214/AJR.07.3277
31. Barrios C, Malinoski D, Dolich M. Utility of thoracic computed tomography after blunt trauma: when is chest radiograph enough? Am Surg. 2009;75:966-9. https://doi.
org/10.1177/000313480907501023
32. Pouragaei M, Montazer M, Moharramzadeh P, et al. Chest CT findings in patients with chest trauma referred to TabrizImam Reza Hospital in 2015: a short report. Iran J Emerg
Med. 8(1):1-10.
33. Safari S, Farbod M, Hatamabadi H, et al. Clinical predictors of abnormal chest CT scan findings followingblunt chest trauma: a cross-sectional study. Chin J Traumatol. 2020;23(1):51-5. https://doi.org/10.1016/j.cjtee.2019.07.007
34. Çorbacıoğlu SK, Er E, Aslan S, et al. The significance of routine thoracic computed tomography in patients with blunt chest trauma. Injury. 2015;46(5):849-53. https://doi.org/10.1016/j.injury.2014.12.022
35. Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging. 2011;2(3):281-95. https://doi. org/10.1007/s13244-011-0072-9
36. Rasooli F, Safaie A, Abdollahi A. Management of penetrating thoracic injury due to foreign body: a case report. Iran J Emerg Med. 2020;6(1):159-61.
37. Hu H. Multi-slice helical CT: scan and reconstruction. Med Phys. 1999;26(1):5-18. https://doi.org/10.1118/1.598470
38. Shah V, Keniya R, Shridharani A, et al. Diagnosis of COVID-19 using CT scan images and deep learning techniques. Emerg Radiol. 2021;28:497-505. https://doi.org/10.1007/s10140-020-01886-y
39. Riquelme D, Akhloufi MA. Deep learning for lung cancer nodules detection and classification in CT scans. AI.2020;1(1):28-67. https://doi.org/10.3390/ai1010003
40. Manoharan DS, Sathesh A. Early diagnosis of lung cancer with probability of malignancy calculation and automatic segmentation of lung CT scan images. J Innov Image Process. 2020;2(4):175-86. https://doi.org/10.36548/jiip.2020.4.002
41. Spinazzola J, Van der Kolk B, Ford JD. Developmental trauma disorder: a legacy of attachment trauma in victimized children. J Trauma Stress. 2021;34(4):711-20.https://doi.org/10.1002/jts.22697
42. Ley EJ, Brown CV, Moore EE, et al. Updated guidelines to reduce venous thromboembolism in trauma patients: a Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2020;89(5):971. https://doi.org/10.1097/TA.0000000000002830
43. Rodney T, Taylor P, Dunbar K, et al. High IL-6 in military personnel relates to multiple traumatic brain injuries and post-traumatic stress disorder. Behav Brain Res. 2020;392:112715. https://doi.org/10.1016/j.bbr.2020.112715
44. Hessami MA, Fakhri M. The study of patients with thorax injury in Kermanshah trauma center. Behbood. 2016;12(2):170-9.
45. Rezaeenasab M, et al. A six-month study of injured patients with chest trauma referred to Ali Ibn Abi Talib Medical Training Center. J Rafsanjan Univ Med Sci. 2016;4(4):242-7.
46. Parag P, Hardcastle TC. Interpretation of emergency CT scans in polytrauma: trauma surgeon vs radiologist. AfrJ Emerg Med. 2020;10(2):90-4. https://doi.org/10.1016/j.afjem.2020.01.008
47. Çelik A, Akoglu H, Omercikoglu S, et al. The diagnostic accuracy of ultrasonography for the diagnosis of rib fractures in patients presenting to emergency department with blunt chest trauma. J Emerg Med. 2021;60(1):90-7.
https://doi.org/10.1016/j.jemermed.2020.06.063
48. Abdolrahimzadeh Fard H, Mahmudi-Azer S, Sefidbakht S, et al. Evaluation of chest CT scan as a screening and diagnostic tool in trauma patients with COVID-19: a crosssectionalstudy. Emerg Med Int. 2021;2021. https://doi.org/10.1155/2021/4188178
49. Hu J, Zheng ZF, Wang SH, et al. Missed rib fractures on initial chest CT in trauma patients: time patterns, clinical and forensic significance. Eur Radiol. 2021;31:2332-9. https://doi.org/10.1007/s00330-020-07310-w
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How to Cite
1.
Ziaei M, dahmardeh Ei ali, Bahmani A. Assessment of Chest CT Scan Findings in Multiple Trauma Patients Admitted to the Emergency Department of Khatam-al-Anbia Hospital in Zahedan in 2023. AJS. 2025;8(1):6-13.
