Immediate Pneumothorax Diagnosis by Surgical Residents Using Portable Ultrasound

Abstract

Objective Feasibility of diagnosis of pneumothorax using handheld ultrasound by non-radiologists shows inconsistent results. The aim of this study is to evaluate the feasibility and accuracy of portable ultrasound for immediate diagnosis of pneumothorax by general surgery residents who underwent short training. Methods Patients who presented to the emergency department of a university hospital with suspected pneumothorax between 10/2018 and 12/2019 were included in the study. Patients underwent ultrasound in 2 points of each hemithorax. Sensitivity and specificity for pneumothorax diagnosis by ultrasound and physical examination were calculated and compared with chest computed tomography (CT). Patients in whom a chest tube was placed prior to ultrasound examination and those who did not undergo a CT scan were excluded from the study. Results A total of 85 patients met the inclusion criteria. Mean age was 40.7 ± 20.2 years. Pneumothorax was found among 46 patients (54%) per chest CT, and of these, 21 (46%) underwent chest tube placement following imaging. Ultrasound showed the highest sensitivity and specificity (95.6% [95% confidence interval {CI} 85.16% to 99.47%] and 97.44% [95% CI 86.40% to 99.67%], respectively). Chest x-ray had the lowest sensitivity (47.8% [95% CI 32.89% to 63.05%]) for pneumothorax detection. Physical examination showed a moderate sensitivity and specificity (82.6% [95% CI 68.58% to 92.18%] and 77.89% [95% CI 60.67% to 88.87%], respectively) for the diagnosis of pneumothorax. Conclusions We found high accuracy rates of 2-point ultrasound in immediate pneumothorax diagnosis when performed by surgical residents who underwent a short ultrasound training. This is a fast and repeatable test, and has the potential for successful implementation in prehospital and military scenarios as well, minimizing unnecessary chest tube placements.

Efficacy of Handheld Ultrasound in Medical Education: A Comprehensive Systematic Review and Narrative Analysis

“…Six studies involved residents (Wilkinson et al, 2014 [48], Andersen et al, 2015 [49], Maetani et al, 2018 [50], Bar et al, 2021 [51], Acheampong et al, 2022 [52]), and two studies included both students and residents (Panoulas et al, 2013 [53]; Mai et al, 2013 [54]). The year of the study was not generally reported for residents [48][49][50][51][52][53][54]. Prior to the intervention, participants had limited experience or no experience in carrying out ultrasounds (either conventional or handheld ones).…”

“…General Electric's Vscan was exclusively used in 11 studies [31][32][33][34][35][36][37][38][39]41,43,49,51,53,54]. Two studies used the Acuson P10 (Siemens, [29,54]), two used the Philips Lumify [50,52], three used the Butterfly iQ [44,45,47], and one used the Ballater Medical 3-in-1 ultrasound probe (Ballater Medical, Edinburgh, UK) [46].…”

“…Compared to physical examination alone, handheld ultrasound has been repeatedly proven to increase physicians' ability to establish correct diagnoses [51,61,62]. A continuous approach to training should be employed to prevent the loss of knowledge and improve image acquisition and interpretation skills.…”