Although CT is the gold standard for identifying PTX, researches pointed out that moving patients to imaging, particularly if they are unwell, can take a lot of time. Furthermore, although chest x-rays are another method for PTX identification, prior research indicates that they may overlook as many as 50% of PTX patients.
POCUS is now a practical emergency imaging technique that may be applied to trauma evaluation at the patient's bedside. Prior research demonstrated the excellent sensitivity and specificity of the modality for PTX. Recent studies, however, have called into doubt how sensitive POCUS is for diagnosing PTX in trauma patients.
Therefore, using the red criteria of the National Expert Panel on Field Triage, 2021, Daniel Singer and team carried out this study to ascertain the accuracy of emergency physician (EP) POCUS in recognizing clinically important PTX in patients with high-severity trauma.
This research looked back at a level 1 trauma center's high-severity trauma cases over a 3-year period. CT scan results or the clinician's statement of a "rush of air" after tube thoracostomy implantation were used to identify whether PTX was present or not. If a patient needed a tube thoracostomy within 2.5 hours of triage, they considered PTX to be clinically severe. Emergency providers' diagnostic test characteristics for POCUS and CXR were computed.
PTX was clinically significant in 40 out of 924 patients. For a sensitivity of 68% (95%CI, 52-80), specificity of 100% (95%CI, 19.8-100), positive predictive value (PPV) of 100% (95%CI, 84-100), and negative predictive value (NPV) of 14.3% (95%CI 2.5-43.9), POCUS found 26/38 who had survived before CT.
The sensitivity to 32/38, 84% (95%CI, 70-93), specificity, PPV 100% (95% CI 87-100), and NPV 25% (95%CI, 4.5-64) were all increased by fellowship-trained EPs reviewing the POCUS. The overall sensitivity and specificity of plain CXR were 48.1% (CI 34.2-62.2) and 99% (CI 97.5-99.6), respectively.
Overall, these findings suggest that POCUS can accurately identify clinically severe PTX, particularly when it is overseen by doctors with fellowship training. Less experienced EPs may need more supervision from more experienced EPs and should use appropriate technique when acquiring and interpreting images.
Reference:
Daniel D Singer, Hayley Scott, Ali Khan, Alexandra Donnelly, Adam J Singer, Isadora Botwinick, Randeep Jawa, Ambika Mukhi, Henry C Thode, Michael Secko, ED accuracy of POCUS in identifying clinically significant PTX in high severity trauma patients., The Journal of Emergency Medicine, 2025, https://doi.org/10.1016/j.jemermed.2025.07.009.
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