PoCUS evaluating blunt thoracic trauma: a retrospective analysis of 18 months of emergency department activity

Abstract

Blunt thoracic injury (BTI) constitutes a common presentation in emergency department: rib fractures are the most common injuries. Chest X-ray (CXR) has a limited sensitivity to identify rib fractures. We perform this retrospective study in our emergency department collecting all patients with BTI during an 18-month period. PoCUS was performed prior to acquire CXR or CT. We evaluated 1672 patients with BTI, and we reported rib fractures in 689 patients (41.21%). PoCUS was performed in 190 patients. PoCUS in emergency medicine has an increasing role, especially in BTI, but less clear is its role in detecting ribs fracture. PoCUS seems to be an effective method for diagnosing rib fracture in patients with blunt chest trauma if collaborative and with a well-isolated trauma. We used the trick of patients' self-positioning probe in the most painful site, and this could reduce the time and the pain of the examination.

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

“…A recent meta-analysis showed a very high accuracy of PoCUS when performed by EPs, with 88% sensitivity and 99% specificity, and it was superior to CXR which had 46% sensitivity and 100% specificity [70]. The findings were similar in another recent meta-analysis, albeit with a somewhat heterogeneous operator group [71], as well as in a recent original prospective observational study [72].…”

“…Two studies from 2017 used the total cases of positive findings of rib fractures found by either LUS or CXR as the criterion standard (assuming that there were no false-positive findings) and found a sensitivity of 81–98% in LUS compared to 41–53% for CXR [73, 74]. A third study found a similar concordance between LUS and CXR and/or CCT [72].…”

Point of Care Ultrasound Identification of Multiple Rib Fractures in a Pediatric Patient with Osteogenesis Imperfecta Type 3

“…The current literature demonstrates that an US is not only a suitable alternative but is superior to radiography at delineating rib fractures. Numerous studies have shown that ultrasonography was able to detect rib fractures not seen in radiographs [ 5 , 6 , 7 , 8 , 9 ]. The reported sensitivity of POCUS to detect rib fractures in a systematic review was 97% with a specificity of 94% [ 9 ] while the sensitivity of chest radiography for detecting rib fractures was only 77% but had a higher specificity of 100%.…”

“…Alongside the improved detection rates, the reported benefits of ultrasonography include decreased cumulative doses of ionising radiation, portability, repeatability, and time savings [ 5 , 6 , 7 , 8 , 9 , 10 ]. The reduction of ionizing radiation is particularly important with OI patients as these patients have been shown to have a small but significant increase in their lifetime cancer risk, especially in pediatric patients with such OI that would more likely warrant very frequent X-ray imaging [ 11 , 12 ].…”

Revisión bibliográfica: alcance de la ecografía de tórax en las salas de urgencia

“…En el caso de los traumatismos cerrados de tórax, puede variar desde una fracture que aporte a la perforación de la pleura, contusión, hemotórax, , neumotórax, etc, en estos casos la capacidad del ultrasonido en detectar estas patologías es dependiente de las particularidades de la enfermedad. (Riccardi et al, 2019) En el caso de fracturas de la parrilla costas se logra evidenciar claramente como perdida de continuidad del elemento óseo, adicionalmente puede estar acompañado de hematoma local.…”