Ann Emerg Med. 1997 Mar;29(3):312-5; discussion 315-6. Related Articles,
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Trauma ultrasound examination versus chest radiography in the detection of
hemothorax.
Ma OJ, Mateer JR.
Department of Emergency Medicine, University of North Carolina, Chapel Hill,
USA. ojma@med.unc.edu
STUDY OBJECTIVE: To compare the sensitivity, specificity, and accuracy of
ultrasonography with those of the initial plain chest radiograph for detection
of hemothorax in trauma patients. METHODS: Data from a prior prospective study
of trauma ultrasonography at a Level I trauma center were retrospectively
analyzed. The medical records of a convenience sample of adult patients who
presented with major blunt or penetrating torso trauma during a 17-month period
were reviewed. Emergency physicians performed a trauma ultrasound examination,
which included evaluation for pleural fluid. Ultrasound interpretations were
recorded before other diagnostic tests were obtained and were not used in
patient management decisions. Records of the study patients were reviewed for
confirmation of the presence or absence of hemothorax by other diagnostic and
therapeutic interventions. The chest radiograph and computed tomography (CT)
scan interpretations were performed by attending radiologists who were not
blinded to patient outcome. RESULTS: Five of the 245 patients enrolled in the
study were excluded because tube thoracostomy was performed before the
ultrasound examination was done. Altogether, 26 of the 240 study patients had
hemothorax, as confirmed by tube thoracostomy or CT. Both ultrasound examination
and the initial chest radiograph resulted in 0 false-positive, 1 false-negative,
25 true-positive, and 214 true-negative findings. Overall, both modailties were
96.2% sensitive, 100% specific, and 99.6% accurate. CONCLUSION: Ultrasonography
is comparable to the initial chest radiograph for accuracy in detection of
hemothorax and may expedite the diagnosis and treatment of this condition for
patients with major trauma.