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Cited by 5Trauma Management and DiagnosisTrauma and Emergency Care StudiesAbdominal Trauma and Injuries

The sensitivity of chest x-ray (CXR) for the detection of significant thoracic injury in children exposed to blast

Sargent, Will, Gibb, Iain·2023·Injury
DOI 10.1016/j.injury.2022.12.001
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Abstract

Introduction Thoracic trauma is an important cause of morbidity and mortality in children exposed to blast and early recognition of these injuries is vital. While numerous studies have investigated the sensitivity of chest X-ray (CXR) for the detection of chest injury in blunt trauma, none have evaluated its performance in paediatric blast injury.Methods CXR and Computed Tomography (CT) thorax findings were compared for 105 children who were injured by blast and presented to the UK Role 3 Hospital, Camp Bastion, Helmand Province, during the recent conflict in Afghanistan from 2011 to 2013. CXR performance was evaluated compared to the 'gold standard' of CT for the detection of significant thoracic injuries, defined as pneumothorax, haemothorax, aortic or great vessel injury, 2 or more rib fractures, ruptured diaphragm, sternal fracture, penetrating fragments and pulmonary contusion or laceration.Results The sensitivity of CXR for the detection of significant injuries was: pneumothorax 43%, haemothorax 40%, contusion 44%, laceration 100%, blast lung 80% and subdermal metallic fragments 75%. CXR missed all cases of diaphragm injury, ≥2 rib fractures, clavicle fracture and pleural effusion, although numbers of each were small. Specificity for CXR injury detection was 94% for contusion and 93% for fragment, and 100% otherwise. The sensitivity and specificity of CXR for identifying an abnormality that would prompt CT imaging was 72% (95% CI 55-85%) and 82% (95% CI 70-90%).Conclusions CXR has a poor sensitivity for the identification of significant thoracic injury in children exposed to blast. We argue that, given the challenge of clinical assessment of injured children and the potential for serious adverse consequences of missed thoracic injuries, there should be a low threshold for the use of CT chest in the evaluation of children exposed to blast.

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  • Chest radiography is one of the most frequently performed diagnostic examinations and plays a key role in the detection and monitoring of pulmonary diseases, cardiac abnormalities, infections, and thoracic trauma.

    “Chest radiography is one of the most frequently performed diagnostic examinations and plays a key role in the detection and monitoring of pulmonary diseases, cardiac abnormalities, infections, and thoracic trauma (5, 6).”

    From Swin-Qwen3: a three-stage vision–language framework for automated radiology report generation with multi-agent verification (2026) · cites this paper as [6]

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Authors
Sargent, W., & Gibb, I.
Affiliations
Imperial College London (GB)
Corresponding author
Sargent, Will
ORCID
Sargent, Will
Venue
Injury
Publisher
Elsevier BV
Published
2023-05
Volume
54
Issue
5
Pages
1292-1296
ISSN
0020-1383 (ISSN-L)
DOI
10.1016/j.injury.2022.12.001
OpenAlex
W4310750642
Cited by
5
References
17
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 1
FWCI
0.95
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Injury (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Trauma Management and Diagnosis
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
  • Health Sciences › Medicine › Surgery › Abdominal Trauma and Injuries
Keywords
thoracic trauma, pneumothorax, hemothorax, pulmonary contusion, rib fractures, diaphragmatic injury, war casualties, Afghanistan conflict
MeSH terms
Child, Contusions, Hemothorax, Humans, Pneumothorax, Rib Fractures, Thoracic Injuries, Radiography, Thoracic, Tomography, X-Ray Computed, Wounds, Nonpenetrating, X-Rays, Lacerations, Lung Injury

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