Diagnostic Accuracy of Ultrasonography in the Initial Evaluation of Patients with Penetrating Chest Trauma

INTRODUCTION: Traumatic chest injuries (TCI) are one of the most common causes of referring to the emergency departments, with high mortality and disability. This study was designed to evaluate the diagnostic accuracy of ultrasonography versus chest X ray (CXR) in detection of hemo-pneumothorax for patients suffering penetrating TCI. METHODS: The present cross-sectional study was performed to evaluate the diagnostic accuracy of ultrasonography in penetrating TCI victims referred to the emergency department of Shahid Kashani and Alzahra Hospitals of Isfahan, Iran, from July 2012 to June 2013. Bedside ultrasonography and plain CXR was done on arrival and three hours after admission. The results of ultrasonography and radiography were separately evaluated by an emergency medicine specialist and a radiologist, who were blind to the aims of the study. Then, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient was considered to evaluate the accuracy of ultrasonography. RESULTS: In this research, 64 patients with penetrating chest trauma were assessed (98.4% male). The mean age of them was 25.6±8.5 years (rang: 13-65). The plain radiography revealed the eight (12.5%) cases of pneumothorax and one (1.6%) hemothorax. The findings of primary ultrasonography also showed the same number of hemo-pneumothorax. Sensitivity and specificity of primary ultrasound in diagnosis of pneumothorax were 100% (95% Cl: 60.7- 100) and 100.0% (95% Cl, 92.0% to 100.0%) and in detection of hemothorax were 100% (95% Cl: 50.5-100) and 100% (95% Cl: 92.8-100), respectively. Sensitivity and specificity of ultrasound in the third hour were 100% (95% Cl: 31.3-100) and 100% (95% Cl: 91.4-100), respectively. CONCLUSION: Findings of the present study have shown that ultrasonography has an acceptable diagnostic accuracy in the initial assessment of patients with penetrating chest trauma. However, because of its dependency on operator proficiency and other limitations more studies are needed in this area.