Chest ultrasound should be used with caution; it underdiagnoses traumatic pneumothorax: Study

USA: The use of chest ultrasound (US) as the primary modality should be used with caution in the initial evaluation of chest trauma, the researchers suggest in a research published in the Journal of Trauma and Acute Care Surgery. 

The study found that the sensitivity of CXR was 78% compared to 65% with the US in CT-confirmed cases of traumatic pneumothorax including clinically significant pneumothorax requiring tube thoracostomy. 

In the initial evaluation of trauma patients with complete ultrasonography of trauma (CUST), ultrasonography for trauma is a widely used tool demonstrating equivalence to computed tomography (CT) for the detection of clinically significant abdominal hemorrhage. Initial reports have shown high sensitivity of CUST for the bedside diagnosis of pneumothorax. 

Jarrett E. Santorelli, UC San Diego School of Medicine San Diego, CA, and colleagues hypothesized that the sensitivity of CUST would be greater than the initial supine chest radiograph (CXR) for pneumothorax detection. 

For this purpose, the researchers performed patients diagnosed with pneumothorax from 2018 through 2020 at a Level I trauma center. It included patients who had a routine supine CXR and CUST performed prior to intervention as well as confirmatory CT imaging. 

 A registered sonographer performed all CUST during the initial evaluation in the trauma bay. An attending radiologist evaluated all imaging. After occult pneumothorax exclusion, subgroup analysis was performed. Immediate tube thoracostomy was defined as tube placement with confirmatory CXR within 8 hours of admission.