Chest Ultrasound vs CXR for Pneumothorax in Trauma

July 21, 2021

Written by Nickolas Srica

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Chest ultrasound performed by trained emergency physicians appears to be more sensitive than supine chest x-ray in identifying pneumothorax in emergency department trauma patients.

Why does this matter?
Bedside ultrasound is fast, portable, noninvasive, and radiation free, and as ultrasound training continues to grow as a staple in emergency medicine residency curricula, we as emergency physicians keep finding more ways to utilize it to provide better care to our patients. Advanced Trauma Life Support guidelines continue to recommend chest x-ray as an adjunct to the primary survey, but should ultrasound be our go-to move to look for pneumothorax instead?

Better (lung) slide that ultrasound machine right into your trauma bay…
This was a Cochrane Database Systematic Review that included 9 total studies comprising 1,271 trauma patients with possible pneumothorax. Patients had to have both a supine chest ultrasound and supine chest x-ray, and confirmation of the ultimate diagnosis of pneumothorax was confirmed by either chest CT or tube thoracostomy. The primary goal was to compare diagnostic accuracy of chest ultrasound to that of chest x-ray, but some subgroup analyses also looked at differences by type of trauma (blunt vs penetrating), type of ultrasound operator (EM physician vs trauma surgeon), and type of ultrasound transducer used (linear vs curvilinear). The overall sensitivity of chest ultrasonography was 0.91 (95% CI 0.85 to 0.94) and specificity was 0.99 (95% CI 0.97 to 1.00). Chest x-ray had a sensitivity of 0.47 (95% CI 0.31 to 0.63) with a specificity of 1.00 (95% CI 0.97 to 1.00). It’s important to remember that ultrasound is very much an operator-dependent skill and not all pneumothoraces will be clinically important, but assuming proper training, ultrasound certainly appears to be the more sensitive study and should be utilized more frequently for the detection of traumatic pneumothoraces in the ED.

Source
Is Chest Ultrasonography Superior to Supine Chest Radiography in Identifying Pneumothorax in Emergency Department Trauma Patients? Annals of Emergency Medicine. 2021 June. doi: 10.1016/j.annemergmed.2020.09.437