“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

Abstract

BackgroundOccult pneumothorax represents a diagnostic pitfall during the primary survey of trauma patients, particularly if these patients require early positive pressure ventilation. This study investigated the accuracy of our proposed rapid model of ultrasound transducer positioning during the primary survey of trauma patients after their arrival at the hospital.MethodsThis diagnostic trial was conducted over 12 months and was based on the results of 84 ultrasound (US) exams performed on patients with severe multiple trauma. Our index test (US) was used to detect pneumothorax in four pre-defined locations on the anterior of each hemi-thorax using the “Anterior Convergent” approach, and its performance was limited to the primary survey. Consecutively, patients underwent chest-computed tomography (CT) with or without chest radiography. The diagnostic findings of both chest radiography and chest ultrasounds were compared to the gold-standard test (CT).ResultsThe diagnostic sensitivity was 78 % for US and 36.4 % for chest radiography (p < 0.001); the specificity was 92 % for US and 98 % for chest radiography (not significant); the positive predictive values were 74 % for US and 80 % for chest radiography (not significant); the negative predictive values were 94 % for US and 87 % for chest radiography (not significant); the positive likelihood ratio was 10 for US and 18 for chest radiography (p = 0.007); and the negative likelihood ratio was 0.25 for US and 0.65 for chest radiography (p = 0.001). The mean required time for performing the new method was 64 ± 10 s. An absence of the expected diffused dynamic view among ultrasound images obtained from patients with pneumothorax was also observed. We designated this phenomenon “Gestalt Lung Recession.”Conclusions“Anterior convergent” chest US probing represents a brief but efficient model that provides clinicians a safe and accurate exam and adequate resuscitation during critical minutes of the primary survey without interrupting other medical staff activities taking place around the trauma patient. The use of the new concept of “Gestalt Lung Recession” instead of the absence of “lung sliding” might improve the specificity of US in detecting pneumothorax.

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

“…26 lower number were found on one point probing chest ultrasound that was examining only the 3rd intercostal space, midclavicular line for detection of pneumothorax found sensitivity of 92% and specificity of 78% which is lower than our results. 27 Study couldn't detect lung point be in six patients with pneumothorax and this is due to the position of such points were different from the position of the four points of BLUE protocol. This could explain why lung point showed sensitivity of 76%, specificity 75% and 76% accuracy (Table 3, Figure 2).…”

Current Trends in the Use of Ultrasound Over Chest X-Ray to Identify Pneumothoraces in ICU, Trauma, and ARDS Patients

“…8 –11 A key component of our review was to assess whether this variability in sensitivities has improved among recently published studies. Despite the presumed improvement in ultrasound technology and sonographic expertise, studies published between 2012-2016 6,26 show no significant improvement in the sensitivity of ultrasound for pneumothorax detection compared to studies from the early 2000s. 27,28 Twelve studies published since 2010, demonstrated an equally broad range of sensitivities (52.8%-96.2%) with the use of TTUS to identify pneumothoraces.…”

“…The studies collected data from 2000-2016, and involved a total of 2,955 patients who developed 793 pneumothoraces as detected by gold standard CT scanning (Table 1). 16 – 27…”

Quantification analysis of pleural line movement for the diagnosis of pneumothorax

“…However, the performance has varied widely between studies. For example, Ziapour and Haji[ 17 ] found that if the pleural movement disappears and the B-line is used, lung ultrasound exhibited a sensitivity of 78% and a specificity of 92% for pneumothorax diagnosis[ 17 ]. Press et al [ 18 ] found a sensitivity of 91.95% and a specificity of 89.10% for the performance of pneumothorax detection via lung ultrasound[ 18 ].…”