Abstract
Summary Background Chest X‑ray (CXR) after thoracic surgery contributes to patient discomfort and costs and is of limited therapeutic value. Lung ultrasound (LU) for pneumothorax may be an alternative to CXR, but diagnostic accuracy data are heterogeneous and biased by insufficient sonographic technique and patient selection. Reported sensitivities range from 0.21 to 1.0. We evaluated the sensitivity of LU on the first day after thoracic surgery under routine conditions. Methods We performed a prospective observational study (trial-ID DRKS00014557). Consecutive patients undergoing lung resection received standardized LU in addition to routine CXR on the first postoperative day. Ultrasound examiner and radiologist were blinded to corresponding X‑ray and ultrasound findings. CXR was used as reference to determine diagnostic test performance of ultrasound. The conformity of sonography- and routine-based therapeutic decisions was evaluated. Results A total of 68 patients were examined. The mean duration of ultrasound was 145 ± 64 s. CXR identified 23 patients with pneumothorax with a mean apex-to-cupola size of 1.5 ± 1.0 cm. Ultrasound detected 18 patients with pneumothorax. The computed sensitivity of LU was 0.48 (95% confidence interval [0.36; 0.60]). Specificity was between 0.81 and 1.0, the negative predictive value 0.76 [0.66; 0.86]. The sensitivity of CXR was 0.56 [0.44; 0.68]. Air leakage via chest tube correlated weakly with CXR (spearman’s rho = 0.26) and moderately with LU (rho = 0.43). The conformity between sonographically based recommendations and the actual therapy based on routine diagnostics was 96%. Conclusions Sensitivity of ultrasound for pneumothorax detection nearly reached CXR and resulted in equally safe patient management. Our data can serve as a pilot study for upcoming larger-scaled controlled trials.
Highlights
Thoracic surgery is usually followed by numerous chest X-rays (CXR)
The primary endpoint was the detection of a postoperative pneumothorax through lung ultrasound (LU) in comparison to CXR
Patients were examined on the first postoperative day and after chest tube removal, and the diagnostic accuracy had to be analysed separately for mathematical reasons as the reference tests differed: CXR was shot mostly in supine position on the first operative day, but exclusively upright in the later course after chest tube removal
Summary
Thoracic surgery is usually followed by numerous chest X-rays (CXR) They are associated with high logistic efforts and patient discomfort, are binding multiple personnel resources (transport, technical assistants, radiologists), are costly, and have very limited diagnostic and therapeutic value [1]. They represent the clinical standard, and there are no recommendations on the appropriate use of chest X-rays in the postoperative course [2]. In the last two decades, lung ultrasound (LU) has been increas- K. Sensitivity of lung ultrasound for the detection of pneumo thorax one day after pulmonary. Sonographic definition of pneumotho- Patient’s position rax Sensitivity of LUS Prevalence of for pneumothorax pneumothorax (%)
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