Departamento de Postgrado, Medicina de Emergencias, Universidad Icesi, Facultad de Ciencias de La Salud, Calle 18 No. 122-135, Cali, Colombia.
Medicina Crítica, Depertamento de Emergencias, Fundación Valle del Lili, Carrera 98 No.18-49, 760032, Cali, Colombia.
Eur J Trauma Emerg Surg. 2021 Jun;47(3):749-755. doi: 10.1007/s00068-020-01459-1. Epub 2020 Aug 17.
The initial evaluation of patients with thoracic trauma remains a diagnostic challenge for surgery and emergency physicians. Chest sonography plays a key role in the approach for this group of patients, through extended and focused evaluation with trauma sonography (E-FAST).
To establish the diagnostic performance of the extension of the thoracic spine sign using chest sonography in trauma to diagnose hemothorax and compare it with the gold standard test chest computed tomography (CT).
This prospective observational study was conducted over 1 year. Patients who attended the emergency room with closed or penetrating thoracic or thoraco-abdominal trauma, an indication for a chest CT as part of a diagnostic evaluation according to institutional protocols, and who previously underwent a chest sonogram to determine the extent of the thoracic spine sign to diagnose hemothorax. Sonographic results were compared to a radiologist's interpretation of the chest CT. The radiologists were blinded to the initial sonogram interpretation.
Seventy-six patients were enrolled with an average age of 32 years. They mainly had closed trauma, which accounted for 77.6% of samples, and 222 chest images were taken. The sensitivity and specificity for this study were 78.7% and 92.6%, respectively, with a positive predictive value and negative predictive value of 65% and 97.8%, respectively.
Extension of the thoracic spine sign allows rapid identification of the presence, and more precisely, the absence of pleural effusion. This, therefore, allows an appropriate diagnosis and approach in the emergency room in patients with chest trauma.
对于外科和急诊医师而言，胸部创伤患者的初始评估仍然是一个诊断挑战。胸部超声检查通过创伤超声检查（E-FAST）进行广泛和有针对性的评估，在该组患者的治疗方法中起着关键作用。
确定胸部超声检查中扩展的胸椎征在创伤中诊断血胸的诊断性能，并与金标准测试胸部计算机断层扫描（CT）进行比较。
这是一项为期 1 年的前瞻性观察研究。该研究纳入了因闭合性或穿透性胸部或胸腹联合伤而到急诊就诊的患者，根据机构方案，胸部 CT 是诊断评估的一部分，且这些患者之前进行过胸部超声检查以确定胸椎征的范围以诊断血胸。将超声结果与放射科医生对胸部 CT 的解释进行比较。放射科医生对初始超声解释不知情。
共纳入 76 例患者，平均年龄为 32 岁。他们主要患有闭合性创伤，占样本的 77.6%，共拍摄了 222 张胸部图像。该研究的灵敏度和特异性分别为 78.7%和 92.6%，阳性预测值和阴性预测值分别为 65%和 97.8%。
胸椎征的扩展可快速识别胸腔积液的存在，更准确地说是不存在胸腔积液。因此，这可以在急诊室对胸部创伤患者进行适当的诊断和处理。
