Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma.
BACKGROUND
The accuracy of combined clinical examination (CE) and chest radiography (CXR) (CE + CXR) vs thoracic ultrasonography in the acute assessment of pneumothorax, hemothorax, and lung contusion in chest trauma patients is unknown.


METHODS
We conducted a prospective, observational cohort study involving 119 adult patients admitted to the ED with thoracic trauma. Each patient, secured onto a vacuum mattress, underwent a subsequent thoracic CT scan after first receiving CE, CXR, and thoracic ultrasonography. The diagnostic performance of each method was also evaluated in a subgroup of 35 patients with hemodynamic and/or respiratory instability.


RESULTS
Of the 237 lung fields included in the study, we observed 53 pneumothoraces, 35 hemothoraces, and 147 lung contusions, according to either thoracic CT scan or thoracic decompression if placed before the CT scan. The diagnostic performance of ultrasonography was higher than that of CE + CXR, as shown by their respective areas under the receiver operating characteristic curves (AUC-ROC): mean 0.75 (95% CI, 0.67-0.83) vs 0.62 (0.54-0.70) in pneumothorax cases and 0.73 (0.67-0.80) vs 0.66 (0.61-0.72) for lung contusions, respectively (all P < .05). In addition, the diagnostic performance of ultrasonography to detect pneumothorax was enhanced in the most severely injured patients: 0.86 (0.73-0.98) vs 0.70 (0.61-0.80) with CE + CXR. No difference between modalities was found for hemothorax.


CONCLUSIONS
Thoracic ultrasonography as a bedside diagnostic modality is a better diagnostic test than CE and CXR in comparison with CT scanning when evaluating supine chest trauma patients in the emergency setting, particularly for diagnosing pneumothoraces and lung contusions.
Pôle d'Anesthésie-Réanimation, Hôpital Michallon, et Université Joseph Fourier, Grenoble, France.
Anne-Claire
AC
Hyacinthe
Pôle d'Anesthésie-Réanimation, Hôpital Michallon, et Université Joseph Fourier, Grenoble, France.
Christophe
C
Broux
Pôle d'Anesthésie-Réanimation, Hôpital Michallon, et Université Joseph Fourier, Grenoble, France.
Gilles
G
Francony
Centre de Recherche Clinique, INSERM 003, Hôpital Michallon, et TIMC-IMAG, UMR-CNRS 5525, Université Joseph Fourier, Grenoble, France.
Céline
C
Genty
Pôle d'Anesthésie-Réanimation, Hôpital Michallon, et Université Joseph Fourier, Grenoble, France.
Pierre
P
Bouzat
Pôle d'Anesthésie-Réanimation, Hôpital Michallon, et Université Joseph Fourier, Grenoble, France.
Claude
C
Jacquot
Pôle d'Anesthésie-Réanimation, Hôpital Michallon, et Université Joseph Fourier, Grenoble, France.
Pierre
P
Albaladejo
Département de Radiologie, Hôpital Michallon, et Université Joseph Fourier, Grenoble, France.
Gilbert R
GR
Ferretti
Centre de Recherche Clinique, INSERM 003, Hôpital Michallon, et TIMC-IMAG, UMR-CNRS 5525, Université Joseph Fourier, Grenoble, France. Electronic address: jfpayen@ujf-grenoble.fr.
Jean-Luc
JL
Bosson
Pôle d'Anesthésie-Réanimation, Hôpital Michallon, et Université Joseph Fourier, Grenoble, France.
Jean-François
JF
Payen
D000328:Adult; D015331:Cohort Studies; D003288:Contusions / Q000000981:diagnostic imaging; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006491:Hemothorax / Q000000981:diagnostic imaging; D006801:Humans; D055370:Lung Injury / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011030:Pneumothorax / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D013030:Spain; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014463:Ultrasonography; D055815:Young Adult