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.
Based on the study, the researchers found the following:
- There were 568 patients screened with a diagnosis of pneumothorax, identifying 362 patients with a confirmed pneumothorax in addition to CXR, CUST, and confirmatory CT imaging.
- The population was 83% male, had a mean age of 45 years, with 85% presenting due to blunt trauma.
- Sensitivity of CXR for detecting pneumothorax was 43%, while the sensitivity of CUST was 35%.
- After removal of occult pneumothorax (n = 171), CXR was 78% sensitive, while CUST was 65% sensitive.
- In this subgroup, CUST had a false-negative rate of 36% (n = 62).
- Of those patients with a false-negative CUST, 50% (n = 31) underwent tube thoracostomy, with 85% requiring immediate placement.
The auhtors wrote in their conclusion, "use of chest US as the primary imaging modality in the initial evaluation of thoracic trauma should be used with caution."
Reference:
Santorelli, Jarrett E. MD; Chau, Harrison MD; Godat, Laura MD; Casola, Giovanna MD; Doucet, Jay J. MD; Costantini, Todd W. MD Not so FAST—Chest ultrasound underdiagnoses traumatic pneumothorax, Journal of Trauma and Acute Care Surgery: January 2022 - Volume 92 - Issue 1 - p 44-48 doi: 10.1097/TA.0000000000003429
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