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. 2013 Mar;14(2):103-8.
doi: 10.5811/westjem.2012.12.12663.

Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax

Bon S Ku  1 , J Matthew Fields, Brendan Carr, Worth W Everett, Vincent H Gracias, Anthony J Dean
Affiliations

Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax

Bon S Ku et al. West J Emerg Med. 2013 Mar.

Abstract

Introduction: Prior studies have reported conflicting results regarding the utility of ultrasound in the diagnosis of traumatic pneumothorax (PTX) because they have used sonologists with extensive experience. This study evaluates the characteristics of ultrasound for PTX for a large cohort of trauma and emergency physicians.

Methods: This was a prospective, observational study on a convenience sample of patients presenting to a trauma center who had a thoracic ultrasound (TUS) evaluation for PTX performed after the Focused Assessment with Sonography for Trauma exam. Sonologists recorded their findings prior to any other diagnostic studies. The results of TUS were compared to one or more of the following: chest computed tomography, escape of air on chest tube insertion, or supine chest radiography 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 549 patients had traumatic PTX, for an incidence of 9%. TUS correctly identified 27/47 patients with PTX for a sensitivity of 57% (confidence interval [CI] 42-72%). There were 3 false positive cases of TUS for a specificity of 99% (CI 98%-100%). A "wet" chest radiograph reading done in the trauma bay showed 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, the sonographic evaluation for pneumothorax was as accurate as supine chest radiography. Thoracic ultrasound may be helpful in the initial evaluation of patients with truncal trauma.

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Figures

Figure 1.
Figure 1.
Ultrasound image of a normal lung shows the parietal pleura (arrow) and ribs (asterisks).
Figure 2.
Figure 2.
Method of final diagnosis of the presence or absence of pneumothorax in patients with truncal trauma. *Physician sonologists performed thoracic ultrasound prior to other imaging modalities.
See this image and copyright information in PMC

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