Ultrasound detection of pneumothorax with minimally trained sonographers: a preliminary study

Prompt recognition and treatment of a tension pneumothorax is critical to reducing mortality in both military and civilian settings. Physician assistants, Special Operations Forces (SOF) and conventional force Medics are often the first medical providers to care for combat trauma patients with penetrating chest trauma and frequently have limited diagnostic capabilities available to them due to mission constraints. The purpose of this study is to examine the potential for non-physician providers to determine the absence or presence of a pneumothorax in a porcine model, with the use of a portable ultrasound machine, after receiving minimal training.

Physician assistants, SOF and conventional force Medics, veterinary technicians, and food service inspectors, all naive to ultrasound, were recruited for this study. Participants underwent a brief presentation on detection of a pneumothorax by ultrasound and were then asked to perform a thoracic ultrasound examination on euthanized, ventilated swine. Some of the swine were induced with a pneumothorax prior to these examinations, and all participants were blinded to the absence or presence of a pneumothorax.

Twenty-two participants examined a total of 44 hemithoraces. A total of 21 out of 22 pneumothoraces were correctly identified with one false-negative. All 22 normal hemithoraces were correctly identified for a sensitivity of 95.4% (95% CI 0.75-0.99), and a specificity of 100% (95% CI 0.81-1.00), with PPV of 100%, NPV of 95.6%.

Non-physician healthcare providers can accurately detect a pneumothorax with portable ultrasound after receiving minimal focused training.