A cross-sectional diagnostic study comparing the sensitivity and specificity of ultrasonography and chest radiography in detecting pneumothorax and hemothorax in patients with chest trauma

Abstract

After head trauma and abdominal injuries, thoracic trauma makes up 20–25% of all traumas and is the third most common cause of death. Moving an unstable patient to the X-ray room in the Emergency Department (ED) is always dangerous to detect pneumothorax and hemothorax. Bedside X-rays expose nearby patients to radiation as well as the patient in question. When chest trauma patients are first imaged, bedside ultrasonography (USG) can help prevent this.

Objective

To assess the efficacy and precision of chest radiography and ultrasonography in identifying hemothorax and pneumothorax in patients with chest trauma.

Methods

At Kingdom of Saudi Arabia Ministry of Health Riyadh health cluster one Imam Abdulrahman AL Faisal hospital a cross-sectional diagnostic study was carried out over the course of a year. The study included all consecutive patients (n = 255) who had a possible history of chest trauma. A point-of-care ultrasonography-trained emergency medicine physician examined the patients at the bedside using USG, and they then had chest radiography to document hemothorax and pneumothorax.
For chest X-rays (CXRs) and ultrasonography, sensitivity and specificity were calculated and compared with the composite gold standard, which consists of computed tomography thorax and chest radiography.

Results

89 percent of the 255 patients were men. The patients' average age was 43.46 years old (standard deviation: 16.3). The most frequent way of injury (81%), was from a road traffic accident (RTA). Four hours (2.5-7) was the median (interquartile range) amount of time that passed between the injury and hospital arrival. In subcutaneous emphysema, 16.1% of the patients were affected. Hemodynamic stability was present in about 88.2% of the patients, and 78% of them also had additional system injuries. When it came to identifying pneumothorax, USG's sensitivity and specificity were 85.7% and 95.3%, respectively, whereas CXR's were 71.4% and 100%. According to our research, CXR had a 62.9% and 100% sensitivity and specificity in diagnosing hemothorax, while USG had a 79% and 97.9% sensitivity and specificity. The sensitivity of USG in diagnosing pneumothorax and hemothorax was higher than that of CXR, even in the subset of patients in whom a computed tomography scan was performed. Within that patient subset, USG had a better specificity for hemothorax detection than CXR, and it had the same specificity for pneumothorax detection as CXR.

Conclusion

When it came to identifying pneumothorax and hemothorax, USG's sensitivity was higher than CXR's. When it came to identifying pneumothorax and hemothorax, USG's specificities were similar to those of CXR. For this reason, bedside ultrasound done by an emergency physician during resuscitation aids in the quick diagnosis and prompt treatment of patients with chest damage.