Traumatic pneumothorax mapping using computed tomography to assess optimal area to scan with POCUS.

Area of Science:

• Emergency Medicine
• Radiology
• Critical Care Ultrasound

Background:

• Traditional teaching for point-of-care ultrasound (POCUS) for pneumothorax detection focuses on the anterior chest.
• Existing POCUS protocols for pneumothorax vary in accuracy and completeness.
• The optimal scanning area for diagnosing pneumothorax requires further investigation.

Purpose of the Study:

• To determine the optimal scanning area for diagnosing traumatic pneumothorax using point-of-care ultrasound (POCUS).
• To map the location of traumatic pneumothoraces identified on computed tomography (CT).

Main Methods:

• Retrospective review of adult patients with pneumothorax diagnosed by CT at a regional trauma center.
• Mapping of pneumothoraces using predefined zones on CT scans.
• Calculation of theoretical sensitivity and confidence intervals for scanning specific areas.

Main Results:

• A total of 203 traumatic pneumothoraces were analyzed.
• The majority of pneumothoraces were located between the parasternal border and mid-clavicular line, from the inferior clavicle to the lung point.
• Scanning this defined area demonstrated a theoretical sensitivity of 91.6% for pneumothorax detection.

Conclusions:

• The study recommends including the area from the inferior clavicle at the parasternal border to the lung point, and along the mid-clavicular line to the lung point, in POCUS protocols for traumatic pneumothorax.
• This refined scanning area enhances diagnostic accuracy for traumatic pneumothorax.