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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Occult pneumothoraces in acute trauma patients
Amy A Ernst1, William A McIntyre, Steven J Weiss
1University of New Mexico, Department of Emergency Medicine, Albuquerque, New Mexico.
The Western Journal of Emergency Medicine
|January 15, 2013
Summary
Chest radiography (CR) detects only half of traumatic pneumothoraces (PTX). PTX size and soft tissue air on CR predict detection, but symptoms do not. Many occult PTXs still receive chest tubes.
Area of Science:
- Medical Imaging
- Trauma Surgery
- Radiology
Background:
- Traumatic pneumothorax (PTX) can be occult on initial chest radiography (CR), becoming apparent only on computed tomography (CT).
- CR is the primary tool for PTX detection, but CT is often performed in trauma patients with thoracoabdominal injuries.
Purpose of the Study:
- To retrospectively evaluate the effectiveness of CR in detecting PTX in trauma patients.
- To identify predictors of PTX detection on CR and assess the management of occult PTX.
Main Methods:
- Retrospective analysis of trauma patients with CT-diagnosed PTX over a 2-year period.
- Inclusion criteria: patients with both CR and chest CT; CT reading as gold standard.
- Statistical analysis included descriptive statistics, chi-squared tests, and regression analysis to identify predictors of PTX on CR.
Main Results:
- Of 134 PTXs, CR detected 49% (sensitivity = 50%).
- CR detected 30-33% of small to large PTXs. PTX size and soft tissue air on CR were predictors.
- Chest tubes were placed in 89% of PTXs seen on CR versus 44% of those only on CT.
Conclusions:
- PTX size and soft tissue air on CR are associated with detection.
- A significant proportion of PTXs not apparent on CR still led to chest tube placement.
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