Extension of the thoracic spine sign as a diagnostic marker for thoracic trauma.

INTRODUCTION

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).

OBJECTIVES

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.