Department of Emergency Medicine, SUNY Downstate/Kings County Hospital Center, Brooklyn, NY, USA.
Acad Emerg Med. 2010 Jan;17(1):11-7. doi: 10.1111/j.1553-2712.2009.00628.x.
Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma.
MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography.
Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from 86% to 98% and 97% to 100%, respectively. The sensitivity of supine AP chest radiographs for the detection of pneumothorax ranged from 28% to 75%. The specificity of supine AP chest radiographs was 100% in all included studies.
This evidence-based review suggests that bedside thoracic US is a more sensitive screening test than supine AP chest radiography for the detection of pneumothorax in adult patients with blunt chest trauma.
对于钝性创伤患者，仰卧前后位（AP）胸部 X 光片对气胸的检出率较低。超声（US）已被提议作为该人群气胸的替代筛选试验。作者对医学文献进行了循证综述，以比较床边 US 和 AP 胸部 X 光片在识别钝性创伤后气胸方面的敏感性。
使用源自以下临床问题 PICO 公式的搜索策略，从 1965 年到 2009 年 6 月在 MEDLINE 和 EMBASE 数据库中搜索试验：包括疑似钝性创伤后气胸的成年（18 岁+）急诊科（ED）患者的患者。干预措施是用于检测气胸的胸部超声。对照是患者初始评估时的仰卧 AP 胸部 X 光片。研究人群中 US 识别气胸存在的诊断性能是结果。气胸存在或不存在的标准是胸部计算机断层扫描（CT）或胸腔引流管放置期间空气快速涌入（不稳定患者）。纳入了由急诊医师（EP）进行的胸部 US 的前瞻性、观察性试验。排除了由放射科医生或外科医生进行的检查的试验，或调查了患有穿透性创伤或自发性或医源性气胸的患者的试验。评估了研究的方法学质量。使用定性方法总结研究结果。数据分析包括胸部 US 和仰卧 AP 胸部 X 光片的测试性能（敏感性和特异性，95%置信区间[CI]）。
确定了 4 项前瞻性观察性研究，共有 606 名符合纳入和排除标准的患者。US 检测气胸的敏感性和特异性范围分别为 86%至 98%和 97%至 100%。仰卧 AP 胸部 X 光片检测气胸的敏感性范围为 28%至 75%。所有纳入研究中仰卧 AP 胸部 X 光片的特异性均为 100%。
这项基于证据的综述表明，床边胸部 US 是一种比仰卧 AP 胸部 X 光更敏感的筛查试验，可用于检测成年钝性胸部创伤患者的气胸。
