A prospective comparison between bedside ultrasound versus chest radiograph and computed tomography scan for the diagnosis of traumatic hemothorax

Abstract

Introduction Injuries to the chest are responsible for most of deaths occurring at the scene of trauma or within 1 h from arriving to hospital (immediate deaths) and many of those within few hours up to 24 h from arriving to hospital (early deaths). Hemothorax often develops after blunt or penetrating trauma. The most common cause of blunt trauma is traffic accidents, and hemothorax is associated with injures of the lung or intercostal vessels caused by broken rib ends as a result of rib fractures, frequently occurring in blunt trauma. Objectives The aim of this study is to evaluate the sensitivity and specificity of chest ultrasound (US) in the detection of traumatic hemothorax and quantification of its size in comparison with chest radiograph and the computed tomography (CT) chest as a gold standard diagnostic tool. Patients and methods This prospective observational study enrolled 80 patients who had hemothorax and admitted to Alexandria University Hospital, screened with chest radiograph, US, and CT scan to determine the accuracy and sensitivity of chest US imaging modality. Moreover, hemodynamic variations were assessed at the time of admission (0 h) and after 12 h. Results Overall, 71% of the patients were males, and 45% of the patients were between 20 and 30 years of age. The mode of trauma in 56% of cases was motor vehicle accidents, and in 33% of cases was falling from height. Moreover, 38% of the patients were intubated. Bedside US sensitivity in detection of traumatic hemothorax in comparison with the CT chest showed sensitivity of 93% on the right-side chest hemothorax and 100% on the left-side chest hemothorax and specificity of 100% on both sides. Conclusions US is a sensitive, specific, and accurate technique for detecting hemothorax in patients with thoracic trauma. CT does detect some hemothoraces not seen on US. However, it can permit early and precise definition of the location of bleeding in patients with trauma who cannot be moved. It is also more readily attainable than CT scan. Therefore, it can be used in patients who are not stable enough for transport and in resource-limited areas.