The potential benefit of emergency ultrasound plus mdct for the diagnosis of major chest trauma … a diagnostic test accuracy study

Abstract

Background: Multidetector computed tomography (MDCT) has established itself as the preferred imaging modality for the evaluation of polytrauma patients owning to its significantly better ability in detecting tissue but patients are exposed to great amount of radiation during MDCT examination. Ultrasound has the benefits of being reliable, dynamic, rapid, noninvasive technique and freed from radiation. Objective: This study aims to ascertain the role of transthoracic ultrasound for imaging blunt chest trauma patients and compared its sensitivity, specificity and accuracy to those of MDCT as a gold standard modality. Patients and methods: This study was carried on 57 patients, 54 males (94.7%) and 3 were females (5.3%) and ages ranged from 5 to 60 years. All patients were exposed to major blunt chest trauma with or without associated polytrauma. Results: With MDCT as the gold standard, the most common injury detected by ultrasound (US) was pleural in 89.5% of patients with 96% accuracy, chest wall lesions were found in 80.7% of patients with 95% diagnostic accuracy, parenchymal lesions were found in 64.9% of patients with 91% diagnostic accuracy and mediastinal lesions were detected in 3.5% with 91% diagnostic accuracy. The sensitivity and specificity of ultrasonography varied for detecting the subsequent pathologies: rib fracture (89% and 100%) subcutaneous emphysema (87% and100 %), hemothorax (94% and 100%), pneumothorax (89% and 100%), hydropneumothorax (81% and 100%), pulmonary contusions (82% and 100%), lung collapse (93% and 100%), lung laceration (100% and 100%) and hemopericardium (100% and100%), respectively. Conclusions: Chest US proved its value for diagnosis of blunt thoracic injuries with acceptable sensitivity and high specificity, particularly for pleural, pericardial and parenchymal lung injuries.