Trauma Ultrasound Examination Versus Chest Radiography in the Detection of Hemothorax

doi:10.1016/S0196-0644(97)70341-X

Annals of Emergency Medicine

Volume 29, Issue 3, March 1997, Pages 312-316

Presented at the Society for Academic Emergency Medicine Annual Meeting, Denver, Colorado, May 1996.

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Abstract

Study objective: To compare the sensitivity, specificity, and accuracy of ultrasonography with those of the initial plain chest radiograph for detection of hemothorax in trauma patients. Methods: Data from a prior prospective study of trauma ultrasonography at a Level I trauma center were retrospectively analyzed. The medical records of a convenience sample of adult patients who presented with major blunt or penetrating torso trauma during a 17-month period were reviewed. Emergency physicians performed a trauma ultrasound examination, which included evaluation for pleural fluid. Ultrasound interpretations were recorded before other diagnostic tests were obtained and were not used in patient management decisions. Records of the study patients were reviewed for confirmation of the presence or absence of hemothorax by other diagnostic and therapeutic interventions. The chest radiograph and computed tomography (CT) scan interpretations were performed by attending radiologists who were not blinded to patient outcome. Results: Five of the 245 patients enrolled in the study were excluded because tube thoracostomy was performed before the ultrasound examination was done. Altogether, 26 of the 240 study patients had hemothorax, as confirmed by tube thoracostomy or CT. Both ultrasound examination and the initial chest radiograph resulted in 0 false-positive, 1 false-negative, 25 true-positive, and 214 true-negative findings. Overall, both modailties were 96.2% sensitive, 100% specific, and 99.6% accurate. Conclusion: Ultrasonography is comparable to the initial chest radiograph for accuracy in detection of hemothorax and may expedite the diagnosis and treatment of this condition for patients with major trauma. [Ma OJ, Mateer JR: Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med March 1997;29:312-316.]

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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There are more references available in the full text version of this article.

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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.^‡

^☆☆: Reprint no.47/1/79383

^★: 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

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Trauma Ultrasound Examination Versus Chest Radiography in the Detection of Hemothorax☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

Acknowledgements

Ann Emerg Med

Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients

J Trauma

A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment

J Trauma

Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians

J Trauma

Ultrasound in blunt abdominal and thoracic trauma

J Trauma

Emergency center ultrasonography in the evaluation of hemoperitoneum: A prospective study

J Trauma