Heydari Farhad, Esmailian Mehrdad, Dehghanniri Masoumeh
Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Emerg (Tehran). 2014 Spring;2(2):81-4.
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.
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.
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.
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.
创伤性胸部损伤（TCI）是急诊就诊的最常见原因之一，具有高死亡率和致残率。本研究旨在评估超声检查与胸部X线（CXR）对穿透性TCI患者血胸和气胸的诊断准确性。
本横断面研究旨在评估2012年7月至2013年6月转诊至伊朗伊斯法罕的沙希德·卡沙尼医院和阿尔扎赫拉医院急诊科的穿透性TCI受害者中超声检查的诊断准确性。患者入院时及入院三小时后进行床边超声检查和胸部X线平片检查。超声检查和X线检查结果分别由一名对研究目的不知情的急诊医学专家和一名放射科医生进行评估。然后，采用敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和kappa系数来评估超声检查的准确性。
本研究共评估了64例穿透性胸部创伤患者（男性占98.4%）。他们的平均年龄为25.6±8.5岁（范围：13 - 65岁）。胸部X线平片显示8例（12.5%）气胸和1例（1.6%）血胸。初次超声检查结果也显示了相同数量的血气胸。初次超声检查诊断气胸的敏感度和特异度分别为100%（95%可信区间：60.7 - 100）和100.0%（95%可信区间，92.0%至100.0%），诊断血胸的敏感度和特异度分别为100%（95%可信区间：50.5 - 100）和100%（95%可信区间：92.8 - 100）。三小时后超声检查的敏感度和特异度分别为100%（95%可信区间：31.3 - 100）和100%（95%可信区间：91.4 - 100）。
本研究结果表明，超声检查在穿透性胸部创伤患者的初始评估中具有可接受的诊断准确性。然而，由于其依赖操作者的熟练程度以及其他局限性，该领域仍需要更多研究。
