Added diagnostic value of mediastinal width combined with other mediastinal radiographic findings in predicting acute traumatic aortic injury in patient with blunt chest injury compared to conventional mediastinal width alone
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Abstract
BACKGROUND: Upper mediastinal width greater than 8 cm on a supine chest radiograph (CXR) is used as an indication for computed tomography angiography (CTA) of the thoracic aorta to detect acute traumatic aortic injury (ATAI). However, this approach frequently reveals no evidence of injury, leading to unnecessary radiation exposure and substantial healthcare costs.
OBJECTIVE: To assess the added diagnostic value of combining mediastinal width with other mediastinal features seen on supine CXR compared with using mediastinal width alone.
METHODS: A retrospective case-control study was conducted on supine CXR of patients with blunt chest injury at Lampang Hospital between 1 January 2013 to 28 February 2023. Baseline variables, mediastinal width, and other radiographic mediastinal features were recorded. CTA thoracic aorta was used as the reference standard. Logistic regression analysis was used to compare a model using mediastinal width alone with a model combining mediastinal width and additional mediastinal findings. The diagnostic performance of the two models was evaluated by comparing the areas under the receiver operating characteristic curve (AUROC).
RESULTS: Eighty patients were included, 40 with and 40 without ATAI. Using mediastinal width alone yielded an AUROC of 0.643 (95% CI: 0.520–0.765). When mediastinal width was combined with other mediastinal features—left mediastinal width, left mediastinal ratio, mediastinal-cardiac ratio and left mediastinal-cardiac ratio—the AUROC increased to 0.899 (95% CI: 0.832-0.965). Moreover, when using the left mediastinal–cardiac ratio alone, the AUROC was 0.895 (95% CI: 0.826–0.963).
CONCLUSIONS AND RECOMMENDATIONS: Combining mediastinal width with other mediastinal features or using left mediastinal-cardiac ratio alone improves the ability to predict ATAI in patients with blunt chest injury. Therefore, these variables should be applied in this patient group.
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