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Observational Study
. 2020 Aug;32(4):626-630.
doi: 10.1111/1742-6723.13482. Epub 2020 Feb 23.

Are expiratory radiographs more sensitive than inspiratory radiographs for the diagnosis of pneumothorax in the emergency department? A retrospective observational study

Philip Stokes  1 , Emma Ballard  2 , Caoimhe McKeating  1 , Joanna Belcher  1 , Karen Furlong  3 , Julia Hocking  4   5 , Catherine Forristal  1
Affiliations
Observational Study

Are expiratory radiographs more sensitive than inspiratory radiographs for the diagnosis of pneumothorax in the emergency department? A retrospective observational study

Philip Stokes et al. Emerg Med Australas. 2020 Aug.

Abstract

Objectives: Expiratory radiographs are sometimes performed in addition to inspiratory radiographs when a diagnosis of pneumothorax is suspected. There is little published evidence to support this practice and most studies suggest the additional radiograph does not confer any benefit in terms of increased sensitivity. The present study is the first to assess if specialist emergency physicians are more likely to detect a pneumothorax on an inspiratory radiograph compared to an expiratory radiograph.

Methods: Across two urban district EDs 103 paired radiographs positive for pneumothorax and 112 negative controls were identified for inclusion in the study. These were reviewed by three specialist emergency physicians who rated them as either positive or negative for pneumothorax.

Results: The mean sensitivity for the three reviewers was 84.8% (95% CI 82.0-87.5) for the inspiratory radiographs and 91.9% (95% CI 88.2-95.6) for the expiratory radiographs, a mean absolute difference of 7.1% (95% CI 2.2-12.1, P = 0.025) in favour of expiratory radiographs.

Conclusions: When reviewed by emergency physicians the present study found expiratory radiographs confer an increase in sensitivity for the diagnosis of pneumothorax compared with inspiratory radiographs. In certain patients where the clinical suspicion for pneumothorax is high performing an expiratory radiograph may increase the likelihood of the diagnosis being made in the ED.

Keywords: emergency medicine; pneumothorax; radiography.

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References

    1. Druda D, Keel A. What is the difference in size of spontaneous pneumothorax between inspiratory and expiratory x-rays. Emerg. Med. J. 2009; 9: 861-3.
    1. MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society, Pleural Disease Guideline 2010. Thorax 2010; 65: ii18-31.
    1. Bradley M, Williams C, Walshaw M. The value of routine expiratory chest films in the diagnosis of pneumothorax. Arch. Emerg. Med. 1991; 8: 115-6.
    1. Schramel F, Golding R, Haakman C, Sutedja T, de Jong K, Postmus P. Expiratory chest radiographs do not improve visibility of small apical pneumothoraces by enhanced contrast. Eur. Respir. J. 1996; 9: 406-9.
    1. Seow A, Kazerooni E, Cascade P, Pernicano P, Meary M. Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumothoraces. Am. J. Roentgenol. 1996; 166: 313-6.

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