title: Comparison of Four Views to Single-view Ultrasound Protocols to Identify Clinically Significant Pneumothorax.
abstract: Ultrasound (US) has been shown to be effective at identifying a pneumothorax (PTX); however, the additional value of adding multiple views has not been studied. Single- and four-view protocols have both been described in the literature. The objective of this study was to compare the diagnostic accuracy of single-view versus four-view lung US to detect clinically significant PTX in trauma patients.
  
  
  
  This was a randomized, prospective trial on trauma patients. Adult patients with acute traumatic injury undergoing computed tomography (CT) scan of the chest were eligible for enrollment. Patients were randomized to a single view or four views of each hemithorax prior to any imaging. USs were performed and interpreted by credentialed physicians using a 7.5-Mhz linear array transducer on a portable US machine with digital clips recorded for later review. Attending radiologist interpretation of the chest CT was reviewed for presence or absence of PTX with descriptions of small foci of air or minimal PTX categorized as clinically insignificant.
  
  
  
  A total of 260 patients were enrolled over a 2-year period. A total of 139 patients received a single view of each chest wall and 121 patients received four views. There were a total of 49 patients that had a PTX (19%), and 29 of these were clinically significant (11%). In diagnosis of any PTX, both single-view and four-view techniques showed poor sensitivity (54.2 and 68%) but high specificity (99 and 98%). For clinically significant PTX, single-view US demonstrated a sensitivity of 93% (95% confidence interval [CI] = 64.1% to 99.6%) and a specificity of 99.2% (95% CI = 95.5% to 99.9%), with sensitivity of 93.3% (95% CI = 66% to 99.7%) and specificity of 98% (95% CI = 92.1% to 99.7%) for four views.
  
  
  
  Single-view and four-view chest wall USs demonstrate comparable sensitivity and specificity for PTX. The additional time to obtain four views should be weighed against the absence of additional diagnostic yield over a single view when using US to identify a clinically significant PTX.
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA. ghelland@medicine.bsd.uchicago.edu.|Department of Medicine, University of Chicago, Chicago, IL. ghelland@medicine.bsd.uchicago.edu.
authors.forename: Gregg
authors.initials: G
authors.lastname: Helland
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Romolo
authors.initials: R
authors.lastname: Gaspari
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Licciardo
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sanseverino
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Ulises
authors.initials: U
authors.lastname: Torres
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Emhoff
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: David
authors.initials: D
authors.lastname: Blehar
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D055370:Lung Injury / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography / Q000379:methods*