Abstract
BackgroundTraumatic pneumothorax (PTx) is common in chest trauma. Its incidence ranges between 10 and 28%. Chest X-ray (CXR) is the traditional imaging for the potential traumatic PTx, while CT chest is considered the gold standard diagnostic tool. However, it requires that the patient to be transferred from the Emergency Department (ED) with its resuscitative facilities. Chest US (E-FAST) has emerged as a sensitive tool that can be used on bedside basis with much higher sensitivity than CXR. The objective of this study was to compare between accuracy and usefulness of the bedside US chest and CT chest in the diagnosis of traumatic PTx, as well as its ability to quantify its size. This was a prospective clinical study that included two hundred patients who have been admitted to the ED. The inclusion criteria included any patient with chest trauma. Exclusion criteria included patients with clinical surgical emphysema, patients with life threatening PTx, and patients who did not undergo CT chest.ResultsForty-seven hemithoraces were proved positive for PTx by CT chest, while forty-five hemithoraces out of those 47 were confirmed by bedside chest US. The sensitivity for chest US is 95.74% in detection of traumatic PTx. No false-positive cases were diagnosed. All of the forty-five hemithoraces diagnosed by chest US have been confirmed by CT scan making a specificity of 100%.ConclusionsChest US is a useful rapid diagnostic tool in the diagnosis and quantification of the traumatic PTx at ED. It avoids the delay in transportation of the critically ill patients to perform CT chest.
Highlights
Traumatic pneumothorax (PTx) is common in chest trauma
Exclusion criteria included patients who presented with clinically detected surgical emphysema, patients who presented with a life threatening PTx, patients who have been already managed with insertion of intercostal drain, and patients who did not either undergo CT chest for not being stable for transportation or did not meet the American College of Radiology appropriateness criteria (ACR APPROPRIATENESS CRITERIA) [7]
The bedside chest Chest ultrasound (US) (E-Focused Assessment with Sonography in Trauma (FAST)) was designed to be performed in such patients by senior emergency physicians who had more than 4-year experience in Extended focused assessment with sonography in trauma (E-FAST) Scan
Summary
Traumatic pneumothorax (PTx) is common in chest trauma. The objective of this study was to compare between accuracy and usefulness of the bedside US chest and CT chest in the diagnosis of traumatic PTx, as well as its ability to quantify its size. This was a prospective clinical study that included two hundred patients who have been admitted to the ED. The inclusion criteria included any patient with chest trauma. Chest trauma constitutes a considerable percentage of traumas globally. It accounts approximately for 10% of trauma admissions [2]. Deaths are usually due to airway obstruction, tension pneumothorax (t-PTx), hemorrhage, or cardiac tamponade [4, 5]
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