Kirkpatrick A W, Sirois M, Laupland K B, Liu D, Rowan K, Ball C G, Hameed S M, Brown R, Simons R, Dulchavsky S A, Hamiilton D R, Nicolaou S
Department of Critical Care Medicine, Foothills Medical Centre, Calgary, Alberta, Canada.
J Trauma. 2004 Aug;57(2):288-95. doi: 10.1097/01.ta.0000133565.88871.e4.
Thoracic ultrasound (EFAST) has shown promise in inferring the presence of post-traumatic pneumothoraces (PTXs) and may have a particular value in identifying occult pneumothoraces (OPTXs) missed by the AP supine chest radiograph (CXR). However, the diagnostic utility of hand-held US has not been previously evaluated in this role.
Thoracic US examinations were performed during the initial resuscitation of injured patients at a provincial trauma referral center. A high frequency linear transducer and a 2.4 kg US attached to a video-recorder were used. Real-time EFAST examinations for PTXs were blindly compared with the subsequent results of CXRs, a composite standard (CXR, chest and abdominal CT scans, clinical course, and invasive interventions), and a CT gold standard (CT only). Charts were reviewed for in-hospital outcomes and follow-up.
There were 225 eligible patients (207 blunt, 18 penetrating); 17 were excluded from the US examination because of battery failure or a lost probe. Sixty-five (65) PTXs were detected in 52 patients (22% of patients), 41 (63%) being occult to CXR in 33 patients (14.2% whole population, 24.6% of those with a CT). The US and CXR agreed in 186 (89.4%) of patients, EFAST was better in 16 (7.7%), and CXR better in 6 (2.9%). Compared with the composite standard, the sensitivity of EFAST was 58.9% with a likelihood ratio of a positive test (LR+) of 69.7 and a specificity of 99.1%. Comparing EFAST directly to CXR, by looking at each of 266 lung fields with the benefit of the CT gold standard, the EFAST showed higher sensitivity over CXR (48.8% versus 20.9%). Both exams had a very high specificity (99.6% and 98.7%), and very predictive LR+ (46.7 and 36.3).
EFAST has comparable specificity to CXR but is more sensitive for the detection of OPTXs after trauma. Positive EFAST findings should be addressed either clinically or with CT depending on hemodynamic stability. CT should be used if detection of all PTXs is desired.
胸部超声检查（扩展型创伤重点超声评估，EFAST）在推断创伤后气胸（PTX）的存在方面已显示出前景，并且在识别仰卧前后位胸部X线片（CXR）遗漏的隐匿性气胸（OPTX）方面可能具有特殊价值。然而，此前尚未评估手持超声在这方面的诊断效用。
在省级创伤转诊中心对受伤患者进行初始复苏期间进行胸部超声检查。使用高频线性探头和连接到录像机的2.4千克超声设备。将用于检测PTX的实时EFAST检查结果与随后的CXR结果、综合标准（CXR、胸部和腹部CT扫描、临床病程及侵入性干预措施）以及CT金标准（仅CT）进行盲法比较。查阅病历以了解住院结局和随访情况。
有225例符合条件的患者（207例钝性伤，18例穿透伤）；17例因电池故障或探头丢失而被排除在超声检查之外。在52例患者中检测到65处（65）PTX（占患者的22%），其中41处（63%）在CXR上为隐匿性，见于33例患者（占总体的14.2%，占行CT检查患者的24.6%）。超声和CXR在186例（89.4%）患者中结果一致，EFAST检查结果更好的有16例（7.7%），CXR检查结果更好的有6例（2.9%）。与综合标准相比，EFAST的敏感性为58.9%，阳性似然比（LR+）为69.7，特异性为99.1%。借助CT金标准，将EFAST与CXR直接比较，观察266个肺野中的每一个，EFAST显示出比CXR更高的敏感性（48.8%对20.9%）。两种检查的特异性都非常高（分别为99.6%和98.7%），阳性似然比也都非常高（分别为46.7和36.3）。
EFAST与CXR具有相当的特异性，但在检测创伤后的OPTX方面更敏感。EFAST检查结果呈阳性时，应根据血流动力学稳定性进行临床处理或行CT检查。如果需要检测所有PTX，则应使用CT。
