Application of Ultrasonography and Radiography in Detection of Hemothorax; a Systematic Review and Meta-Analysis.
BACKGROUND
Hemothorax is one of the most prevalent injuries caused by thoracic traumas. Early detection and treatment of this injury is of utmost importance in prognosis of the patient, but there are still controversial debates on the diagnostic value of imaging techniques in detection of hemothorax. Therefore, the present study aimed to evaluate the diagnostic value of chest ultrasonography and radiography in detection of hemothorax through a systematic review and meta-analysis.


METHODS
Two independent reviewers performed an extended systematic search in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. Data were extract and quality of the relevant studies were assessed. The number of true positive, false positive, true negative and false negative cases were extracted and screening performance characteristics of two imaging techniques were calculated using a mixed-effects binary regression model.


RESULTS
Data from 12 studies were extracted and included in the meta-analysis (7361 patients, 77.1% male). Pooled sensitivity and specificity of ultrasonography in detection of hemothorax were 0.67 (95% CI: 0.41-0.86; I2= 68.38, p<0.001) and 0.99 (95% CI: 0.95-1.0; I2= 88.16, p<0.001), respectively. These measures for radiography were 0.54 (95% CI: 0.33-0.75; I2= 92.85, p<0.001) and 0.99 (95% CI: 0.94-1.0; I2= 99.22, p<0.001), respectively. Subgroup analysis found operator of the ultrasonography device, frequency of the transducer and sample size to be important sources of heterogeneity of included studies.


CONCLUSIONS
The results of this study showed that although the sensitivity of ultrasonography in detection of hemothorax is relatively higher than radiography, but it is still at a moderate level (0.67%). The specificity of both imaging modalities were found to be at an excellent level in this regard. The screening characteristics of ultrasonography was found to be influenced of the operator and frequency of transducer.
Sina Trauma and Surgery Research Center, Tehran University Medical Sciences, Tehran, Iran.
Vafa
V
Rahimi-Movaghar
Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mahmoud
M
Yousefifard
Department of Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Parisa
P
Ghelichkhani
Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Masoud
M
Baikpour
Department of Neurology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.; Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.
Abbas
A
Tafakhori
Department of Occupational Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Hadi
H
Asady
Department of Emergency Medicine, Maragheh University of Medical Sciences, Maragheh, Iran.
Gholamreza
G
Faridaalaee
Department of Epidemiology and Biostatistics, school of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Mostafa
M
Hosseini
Department of Emergency Medicine, Shohedaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Saeed
S
Safari
Hemothorax; diagnostic tests; radiography; routine; ultrasonography