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

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.

Diagnostic Accuracy of Chest Ultrasound versus Plain Chest X-ray in Acute Assessment of Traumatic Hemothorax

“…Blunt trauma was the most common type of trauma (79.8%). This agreed with Salama et al (9) who showed that males were more common than females (92%), the mean age was 32 years old, and blunt trauma (due to motor car accident and falling from height) was more than penetrating one (80%). Our results also came in accordance with Vargas et al (10) who showed that among seventy-six patients included in their study, there were 60 males (79%).…”

“…The signs included tenderness (82.3%), hypoxia (25%), shock (38.5%), tachypnea (46.9%) and tachycardia (35.8%). Similar results were reported by Salama et al (9) who showed that the most common presentation of the patients with chest trauma is chest pain (88%), and dyspnea (72%).…”

Diagnostic Accuracy of Chest X-Ray in the Detection of Pneumothorax in Blunt Chest Trauma Patients With Ct as the Gold Standard

“…Khaled Morsy Salama et al 2 in their study found that supine Chest X-Ray showed sensitivity (75%), specificity (88.9%), PPV(76%), NPV(75%) and accuracy (80%); and the specificity and sensitivity of chest ultrasound in diagnosing pneumothorax was 100% and 81% respectively, with overall accuracy 88%. They concluded that the diagnostic accuracy of supine Chest X-Ray were good numbers but still lower than chest ultrasound.…”

“…Chest ultrasound has also been increasingly used to evaluate pneumothorax considering the real-time bedside evaluation especially with critical patients without interruption in the resuscitation process. Various studies 8,9,10,11 have also shown that chest ultrasound has higher sensitivity and specificity in the diagnosis of pneumothorax as compared with chest X-ray. However, chest ultrasound has its limitations in cases of patients with subcutaneous emphysema which in common in traumatic pneumothorax.…”

Diagnostic Accuracy of Ultrasound in the Detection of Pneumothorax in Chest Trauma Patients With Ct as the Gold Standard

“…Khaled Morsy Salama et al(2017) 6 performed a study to assess the accuracy of bedside chest ultrasound in detection of pneumothorax in chest trauma patients in which 50 patients were enrolled. All the patients underwent chest ultrasound, Chest X-Ray, and chest CT.…”