Occult Pneumothorax Identification on Extended Focused Assessment with Sonography for Trauma Examination in Children
Daniel Malek1, Genevieve Santillanes2, Victor Hsiao3
1From the Eastern Virginia Medical School, Norfolk, VA.
Insights
The Extended Focused Assessment with Sonography for Trauma (eFAST) examination did not detect any occult pneumothoraces (OPTXs) in pediatric blunt trauma patients. This study suggests eFAST is not a reliable tool for identifying these subtle injuries in this population.
Area of Science:
- Emergency Medicine
- Pediatric Trauma
- Diagnostic Imaging
Background:
- Occult pneumothoraces (OPTXs) are air in the pleural space missed on conventional chest radiographs (CXR).
- Accurate diagnosis of OPTXs is crucial in pediatric blunt trauma management.
Purpose of the Study:
- To evaluate the diagnostic performance of the Extended Focused Assessment with Sonography for Trauma (eFAST) in detecting occult pneumothoraces (OPTXs).
- To compare eFAST findings with chest computed tomography (CCT) in pediatric blunt trauma patients.
Main Methods:
- Secondary analysis of pediatric blunt trauma patients (<18 years) who underwent CCT.
- Review of eFAST examinations performed by emergency medicine residents or attendings.
- Comparison of eFAST results with CCT-diagnosed small or trace pneumothoraces.
Main Results:
- Out of 168 pediatric trauma patients, 16 had OPTXs on CCT not visible on CXR.
- 4 additional patients had small/trace pneumothoraces without a prior CXR.
- None of the identified OPTXs were detected by the eFAST examination.
Conclusions:
- The standard eFAST examination demonstrated poor performance in detecting occult pneumothoraces in this pediatric blunt trauma cohort.
- Further research is needed to improve ultrasound-based detection of OPTXs in pediatric trauma.
Objective:
Occult pneumothoraces (OPTXs) are defined by air within the pleural space that is not visible on conventional chest radiographs (CXR). The aim of this study was to understand how frequently the Extended Focused Assessment with Sonography for Trauma (eFAST) examination identifies occult PTX in a pediatric blunt trauma population as compared with a criterion standard of chest computed tomography (CCT).
Methods:
This study is a secondary analysis of blunt trauma patients younger than 18 years who underwent CCT at Los Angeles County +USC Medical Center Emergency Department from October 2015 to April 2017. The eFAST examination was performed and documented by an emergency medicine resident with attending oversight or by an emergency medicine attending for each trauma. The eFAST results were reviewed for patients diagnosed with small or trace pneumothoraces identified on CCT.
Results:
Of 168 pediatric trauma patients undergoing CCT, 16 had OPTXs not seen on CXR and 4 patients had a small/trace PTX without a corresponding CXR performed. None were identified on eFAST.
Conclusions:
Although the sample size in this data set was small, our eFAST examinations identified none of 16 proven and 4 presumed OPTXs. The standard eFAST examination performed poorly in the detection of OPTXs in this single-center study of pediatric blunt trauma victims.
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