Role of bedside sonography in the assessment of patients with chest trauma in the emergency department of Suez Canal University Hospital

Khaled Morsy Salama; Islam Mohamed Elshaboury; Walid Mosallam Huissen; Hany Anees Eldomiaty; Karima Ibrahim Elghoboshy

doi:10.18203/2349-2902.isj20170192

Authors

Khaled Morsy Salama Department of Emergency, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Islam Mohamed Elshaboury Department of Emergency, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Walid Mosallam Huissen Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Hany Anees Eldomiaty Department of Cardiothoracic surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Karima Ibrahim Elghoboshy Department of Emergency, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20170192

Keywords:

Chest ultrasound, Chest trauma, Haemothorax, Lung contusion, Pneumothorax

Abstract

Background: Chest trauma is responsible for more than 20 to 25% of all traumatic death. Chest trauma is the second leading cause of traumatic death in each year. In order to keep the prognosis of patients with chest trauma relatively good, the patient should be diagnosed rapidly & managed adequately. Chest ultrasound is a safe, rapid and accurate method in diagnosing chest trauma.

Methods: A total of 50 patients were enrolled in this study. Objectives were to assess the accuracy of bedside chest US in detection of either haemothorax, pneumothorax or lung contusion in chest trauma patients. All the patients underwent chest US, CXR, and chest CT. The data from ultrasound and CXR were compared with the gold standard CT. Then the accuracy of which were calculated.

Results: Showed that Motorcar accidents are the most common cause for chest trauma and most patients were presented by chest pain and dyspnea. Chest ultrasound specificity in diagnosing pneumothorax was higher than sensitivity, 100% and 81% respectively, with over all accuracy 88%. Supine CXR showed sensitivity (75%), specificity (88.9%) and accuracy (80%) which are good numbers but still lower than chest US. Chest US Detection of haemothorax by chest had showed 100% sensitivity, 90% specificity and 96% accuracy.

Conclusions: Chest ultrasound is highly accurate tool for detection of pneumothorax, haemothorax and less lung contusion in chest trauma. Chest ultrasound is a useful tool for the emergency physician for bedside rapid and accurate diagnosis without interruption of the resuscitation and without transferring the patient for the radiology unit.

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References

Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009;33(5):1425-33.

Sharma A, Jindal P. Principles of diagnosis and management of traumatic pneumothorax. J emergencies, trauma Shock. 2008;1:34-41.

Nagarsheth K, Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg. 2011;77(4):480-4.

Bledsoe BE, Porter RS. EMT-P RACMS. Essentials of Paramedic Care Update (2nd Edition). Prentice Hall; 2010.

Mattox KL, Moore EE, Feliciano DV. Trauma, Seventh Edition. McGraw-Hill Education / Medical; 2012.

Szentkereszty Z, Trungel E, Posan J, Sapy P, Szerafin T, Sz Kiss S. Current issues in the diagnosis and treatment of penetrating chest trauma. Magy Seb. 2007;60(4):199-204.

Lomoschitz FM, Eisenhuber E, Linnau KF, Peloschek P, Schoder M, Bankier AA. Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms. Eur J Radiol. 2003;48(1):61-70.

Scaglione M, Pinto A, Pedrosa I, Sparano A, Romano L. Multi-detector row computed tomography and blunt chest trauma. Eur J Radiol. 2008;65(3):377-88.

Neff MA, Monk JS, Peters K, Nikhilesh A. Detection of occult pneumothoraces on abdominal computed tomographic scans in trauma patients. J Trauma. 2000;49(2):281-5.

Hehir MD, Hollands MJ, Deane SA. The accuracy of the first chest x-ray in the trauma patient. ANZ J Surg. 1990;60(7):529-32.

Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of blunt thoracic trauma. Radio Graphics. 2008;28(6):1555-70.

Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-9.

Kirkpatrick A, Ng A, Dulchavsky S, Lyburn I, Harris A, Torregianni W, et al. Sonographic diagnosis of a pneumothorax inapparent on plain radiography: confirmation by computed tomography. J Trauma. 2001;50(4):750-2.

Donmez H, Tokmak TT, Yildirim A, Buyukoglan H, Ozturk M, Yaşar Ayaz Ü, et al. Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma? J Clin Ultrasound. 2012;40(3):142-6.

Ebrahimi A, Yousefifard M, Kazemi HM, Rasouli HR, Asady H, Jafari AM, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos. 2014;13(4):29-40.

Helmy S, Beshay B, Abdel Hady M, Mansour A. Role of chest ultrasonography in the diagnosis of lung contusion. Egypt J Chest Dis Tuberc. 2015;64(2):469-75.

Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010;17(1):11-7.

Kaya SO, Karatepe M, Tok T, Onem G, Dursunoglu N, Goksin I. Were pneumothorax and its management known in 15th-century anatolia? Tex Heart Inst J. 2009;36(2):152-3.

Chin EJ, Chan CH, Mortazavi R, Anderson CL, Kahn CA, Summers S, et al. A pilot study examining the viability of a prehospital assessment with ultrasound for emergencies (PAUSE) protocol. J Emerg Med. 2013;44(1):142-9.

Lichtenstein DA, Mezière G. Relevance of lung ultrasound in the diagnosis of acute respiratory failure the BLUE protocol. Chest. 2008;134(1):117-25.

Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. 2012;29(1):19-23.

Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, et al. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care. 2006;10(4):R112.

WHO, World Health Organisation. The 10 leading causes of death in the world, 2000 and 2012. Fact sheet N°310; 2014.

Volpicelli G, Boero E, Sverzellati N, Cardinale L, Busso M, Boccuzzi F, et al. Semi-quantification of pneumothorax volume by lung ultrasound. Intensive Care Med. 2014;40(10):1460-7.

Chardoli M, Hasan-Ghaliaee T, Akbari H, Rahimi-Movaghar V. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma. Chinese J Traumatol = Zhonghua chuang shang za zhi / Chinese Med Assoc. 2013;16(6):351-4.

Garofalo G, Busso M, Perotto F, Pascale A De, Fava C. Ultrasound diagnosis of pneumothorax. Radiol Med. 2006;111(4):516-25.

Ziapour B, Haji HS. Anterior convergent chest probing in rapid ultrasound transducer positioning versus formal chest ultrasonography to detect pneumothorax during the primary survey of hospital trauma patients: a diagnostic accuracy study. J Trauma Manag Outcomes. 2015;9(1):9.

Paschos KA, Boulas K, Vrakas X. Occult post-traumatic pneumothorax: too early to recognise, simply missed or truly occult? Hell J Surg. 2012;84(2):134-41.

Lichtenstein D, Mezière G, Biderman P, Gepner A. The lung point: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26(10):1434-40.

Jalli R, Sefidbakt SHJ. Value of ultrasound in diagnosis of pneumothorax. Emerg Radiol. 2013;20(2):131-4.

Grimberg A, Shigueoka DC, Atallah AN, Ajzen S, Iared W. Diagnostic accuracy of sonography for pleural effusion: systematic review. Sao Paulo Med J. 2010;128(2):90-5.

Ma OJ, Mateer JR, Scalea TM, Sclafani SJA. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29(3):312-6.

Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG. Chest ultrasonography in lung contusion. Chest. 2006;130(2):533-8.

Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Ghanbari MJH, et al. Diagnostic accuracy of ultrasonography and radiography in detection of pulmonary contusion; a systematic review and meta-analysis. An Acad Emerg Med J. 2015;3(4):127-36.

Hyacinthe AC, Broux C, Francony G, Genty C, Bouzat P, Jacquot C, et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012;141(5):1177-83.