Diagnosis accuracy of thoracic ultrasonography in severely injured patients

Introduction

Thirty-three percent of severely injured patients suffer from thoracic trauma [1]. Diagnosis of pleural and pulmonary lesions at the bedside in the emergency department is difficult. Clinical examination (CE) and chest X-ray (X-ray) have limited sensibility and specificity. Contrast-enhanced computed tomography (CT scan) is the gold standard. CT scan has limitations: it takes time to be performed, implies transport of severely injured patients, and has ionising effects. Thoracic ultrasonography (US) can be quickly performed at the bedside in the emergency room. It has good diagnosis accuracy in ARDS patients [2]. The purpose of this study is to evaluate the diagnosis accuracy of US in severely injured patients in the emergency room.

Methods

We prospectively evaluated 90 patients (median age: 41 (7–89) years) who were admitted to the emergency room of the Grenoble University Hospital over a period of 9 months. Pneumothorax, hemothorax and alveolar consolidation were diagnosed by CE, X-ray and US. The physician who performed the US was not involved in the patient's management. The diagnosis accuracy of each technique is compared with the CT scan interpreted by the radiologist.

Results

Sixty percent of patients had a chest trauma IGS II 22 (8–104), ISS 20 (0–59), thorax AIS 2 (0–5), SOFA 1 (0–11), oxygen saturation at the entrance 100% (74–100), mechanical ventilation for 56% of patients. We studied 179 hemithorax. For hemothorax (n = 16), the sensitivity/specificity/positive predictive value/negative predictive values (%) were CE: 13/95/18/92; X-ray: 13/95/20/92; US: 63/95/56/96. For pneumothorax (n = 30), CE: 20/96/50/86; X-ray: 17/100/100/86; US: 53/93/62/91. For alveolar consolidation (n = 100), CE: 17/95/81/47; X-ray: 29/98/94/52; US: 69/82/83/67.

Conclusion

Ultrasonography has a better sensitivity than CE and X-ray with a comparable specificity. In the emergency room it is a reliable modality for the diagnosis of pneumothorax, hemothorax and alveolar consolidation in the severely injured patient.