Trauma Ultrasound Examination Versus Chest Radiography in the Detection of Hemothorax☆,☆☆,★
Section snippets
INTRODUCTION
During the last 15 years, the use of ultrasonography by emergency physicians and surgeons for accurate identification of free intraperitoneal fluid and pericardial fluid in trauma patients has been well documented.1, 2, 3, 4, 5, 6, 7, 8, 9 Although the accuracy of ultrasonography in the identification of hemoperitoneum is established, few studies have examined its accuracy for identification of hemothorax.3, 5 Because patients who have sustained major trauma routinely present to the emergency
MATERIALS AND METHODS
This retrospective study used data gathered from a prospective study3 of ED patients who had sustained major blunt or penetrating torso trauma. The prospective study was approved by the Medical College of Wisconsin's investigational review board and was conducted between July 1, 1992, and November 30, 1993. Investigational review board exemption was obtained for this retrospective study.
The study was conducted in an ED with an annual volume of 60,000 patients that serves as a Level I trauma
RESULTS
Five of the 245 patients enrolled in the study were excluded because tube thoracostomy was performed before the ultrasound examination was done. Of the remaining 240 patients, 160 (66.7%) had sustained blunt trauma and 80 (33.3%) had penetrating trauma. Altogether, 26 (10.8%) of the 240 study patients had hemothorax confirmed by tube thoracostomy or CT scan, or both. Of these, 8 (30.8%) were patients with blunt trauma, and 18 (69.2%) were patients with penetrating trauma.
When the results of the
DISCUSSION
This study demonstrates that the trauma ultrasound examination can serve as a sensitive, specific, and accurate diagnostic tool for detection of hemothorax in patients with major trauma. The data show that ultrasonography is comparable to chest radiography for identification of hemothorax.
Trauma patients may benefit from the speed and accuracy of ultrasonography. The mean time for rapid trauma ultrasound examination of the thoracic and abdominal cavities has been reported to be 4.0 minutes.3 Of
Acknowledgements
The authors thank Nancy Weaver, MPH, for her assistance with the statistical analysis in this study.
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From the Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina*; and the Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.‡
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Reprint no.47/1/79383
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Address for reprints: O John Ma, MD Department of Emergency Medicine Campus Box 7594 University of North Carolina School of Medicine Chapel Hill, North Carolina 27599-7594 919-966-5958 Fax 919-966-3049 E-mail [email protected] Web site http//www.med.unc.edu/wrkunits/2depts/emergmed/references.htm