title: [Transesophageal echocardiography for diagnosis of traumatic injuries to the major intrathoracic vessels in 150 patients: the effect of the learning curve].
abstract: OBJECTIVE
  To evaluate the role of transoesophageal echocardiography (TOE) in the management of patients with suspected traumatic lesions of the thoracic aorta (TLA) and its branches; to assess the influence of the learning curve on the diagnostic accuracy of TOE for the identification of TLA.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  The study included 150 patients (age: 41 +/- 17; Injury Severity Scale score: 31 +/- 17) who were admitted during a 4-year period for severe blunt chest trauma and who underwent a TOE study.
  
  
  METHODS
  TOE were performed with either a monoplane (n = 54) or a multiplane probe (n = 96). In all cases, TLA were confirmed by angiography, computed tomography, surgery, or necropsy. Initially performed routinely, angiography was subsequently indicated when the TOE study was inconclusive or when a disruption of supraaortic arteries was suspected. Echocardiographic studies were reviewed by an experienced reader who was unaware of the medical history and initial conclusions. To evaluate the influence of the learning curve on the diagnostic accuracy of TOE, these conclusions were compared with the initial interpretations.
  
  
  RESULTS
  A TLA was recognized in 25 patients out of 150 (17%), and evidenced using TOE in 22 of them. Three false negative and two false positive TOE results (needless thoracotomy) were recorded. After a learning period, the rate of inconclusive TOE studies decreased (18/150 vs 7/150: P < 0.05) and no false positive finding was recorded. The sensitivity and specificity of TOE for the diagnosis of TLA were 88 and 100%, and positive and negative predictive values were 100 and 97%, respectively.
  
  
  CONCLUSIONS
  TOE is an accurate imaging technique for the diagnosis of TLA located at the aortic isthmus. However aortography becomes essential when injuries of the aorta branches are suspected. A learning period is required to improve the specificity of TOE for this indication.
authors.affiliation: Service de réanimation polyvalente, CHU Dupuytren, Limoges, France.
authors.forename: P
authors.initials: P
authors.lastname: Vignon
authors.forename: G
authors.initials: G
authors.lastname: Rambaud
authors.forename: B
authors.initials: B
authors.lastname: François
authors.forename: E
authors.initials: E
authors.lastname: Cornu
authors.forename: H
authors.initials: H
authors.lastname: Gastinne
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000293:injuries*; D017548:Echocardiography, Transesophageal; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D013908:Thoracotomy; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging