Results of a prospective study suggest that lung ultrasonography performed in the emergency department may be nearly as accurate as computed tomography (CT) in detecting occult traumatic pneumothorax (PTX) and its size.
"Although presently considered to be the reference diagnostic standard for PTX, CT lung scanning may have some disadvantages, including the need for patient transportation and high doses of radiation," the study team notes in the January issue of
Chest.Based on their study and others, they say an "ever growing weight must be given to the necessity of using (lung ultrasonography) in the initial evaluation of the trauma patient admitted to the ED."
In an 18-month prospective study, Dr. Gino Soldati from Ospedale di Castelnuovo Garfagnana in Lucca, Italy and colleagues quantitatively compared the accuracy of lung ultrasound with that of chest radiography and lung CT in the diagnosis of radiooccult PTX in the ED. Study subjects included 109 conscious, spontaneously breathing patients admitted to the ED for chest trauma or polytrauma.
According to the investigators, spiral CT detected 25 traumatic PTXs in the 218 hemithoraxes evaluated. Of these, only 13 (52 per cent) were revealed by chest radiography. In contrast, lung ultrasound identified 23 of 25 PTXs (92 per cent), with only one false-positive result, for a sensitivity of 92 per cent and specificity of 99.4 per cent.
Moreover, "in 20 of 25 cases, there was agreement on the extension of the PTX between CT lung scan and lung ultrasound, with a mean difference of 1.9 centimeters in the localization of retroparietal air extensions," they report. Chest radiography did not yield quantitative results.
Based on this study, Dr. Soldati and colleagues "propose the use of lung ultrasonography as a tool for the diagnosis and semiquantification of traumatic PTX in the ED."
"We believe that echocardiographic evaluation of the thorax should be performed during the primary survey as an extension of the FAST (focused assessment with sonography for trauma) examination in every trauma patient," they write. "This could help to identify a significant number of radiooccult PTXs and give therapeutic indications as to the follow-up and treatment of this category of patients, avoiding patient transport and a large amount of ionizing radiation."
Source: Reuters
