Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax

Abstract

Introduction: Prior studies have reported conflicting results regarding the utility of ultrasound in thediagnosis of traumatic pneumothorax (PTX) because they have used sonologists with extensiveexperience. This study evaluates the characteristics of ultrasound for PTX for a large cohort oftrauma and emergency physicians.Methods: This was a prospective, observational study on a convenience sample of patientspresenting to a trauma center who had a thoracic ultrasound (TUS) evaluation for PTX performedafter the Focused Assessment with Sonography for Trauma exam. Sonologists recorded theirfindings prior to any other diagnostic studies. The results of TUS were compared to one or more ofthe following: chest computed tomography, escape of air on chest tube insertion, or supine chestradiography followed by clinical observation.Results: There were 549 patients enrolled. The median injury severity score of the patients was 5(inter-quartile range [IQR] 1-14); 36 different sonologists performed TUS. Forty-seven of the 549patients had traumatic PTX, for an incidence of 9%. TUS correctly identified 27/47 patients with PTXfor a sensitivity of 57% (confidence interval [CI] 42-72%). There were 3 false positive cases of TUSfor a specificity of 99% (CI 98%-100%). A “wet” chest radiograph reading done in the trauma bayshowed a sensitivity of 40% (CI 23-59) and a specificity of 100% (99-100).Conclusion: In a large heterogenous group of clinicians who typically care for trauma patients, thesonographic evaluation for pneumothorax was as accurate as supine chest radiography. Thoracicultrasound may be helpful in the initial evaluation of patients with truncal trauma.

Keywords

• emergency medicine
• emergency department
• ultrasound
• technology at the bedside
• traumatic pneumothorax