Pneumothorax can be life threatening in patients with critical thoracic trauma and requires quick and accurate management. Ultrasonography is safe, quick to perform at bedside, efficient, accurate, readily available and cost-effective in ED and can help in prompt detection of pneumothorax.
Aims and objectives: We conducted the present study to compare and correlate the accuracy of bedside ultrasonography in patients with thoracic trauma, with Chest X ray and CT scanning.
Materials and methods: A single centred prospective observational study was done on 175 patients after ethical commitee approval in Department of Emergency Medicine at Civil hospital, Ahmedabad over a period of 18 months from May 2013 to November 2014 and after obtaining consent of patients/relatives, data was collected.
Observations and results: Out of 175 patients presenting to ED with thoracic trauma, pneumothorax was present in 24.6% (43) patients between May 2013 and November 2014 as diagnosed by Gold Standard (CT scan). EFAST examination was performed as an adjunct to primary survey in our patients and was positive in 41.1% (72) patients of whom 59.7% (43) patients had pneumothorax. EFAST was followed by Chest X ray and pneumothorax was confirmed by CT scan. In unstable patients, it was also confirmed initially by air bubbles on intercostal drainage, followed by CT scan. On EFAST, anterior “lung sliding” and comet-tail artifacts (B lines) were absent in 95.3% (41) patients, Barcode sign and Lung point sign was present in 95.3% (41) patients with pneumothorax and absent in 100% (132) cases without pneumothorax. (P value<0.05). In our study, Kappa index for ultrasonography was 0.969+/ 0.022 indicating ultrasound findings showed a very good correlation with CT scan findings.
Conclusion: Ultrasound is portable, simple, quick, and has higher sensitivity and accuracy compared to Chest X ray and may precede it in the evaluation of injured patients performed at any time, in any place, and on any patient. Hence, it is the ideal method for emergency conditions allowing immediate diagnosis and management of pneumothorax with better outcomes.