Acil Servise Künt Toraks Travması ile Başvuran Hastalarda Pnömotoraks, Kosta Kırıkları ve Hemotoraks’ın Değerlendirilmesinde Ultrasonografinin Etkinliği

Abstract

Amaç: Acil Servise Künt Toraks Travmaları (KTT) ile başvuran hastalarda pnömotoraks, hemotoraks ve kosta kırıklarının teşhisinde Ultrasonografi (USG)’nin etkinliğini ve Acil Servislerde bu amaçla kullanımının uygun olup olmadığını tespit etmeyi amaçladık.

Gereç ve Yöntemler: Bu çalışma Ankara Eğitim Araştırma Hastanesi Acil Servisine 15 Temmuz 2011 – 15 Ocak 2012 tarihleri arasında KTT ile başvuran 18 yaş üzeri hastalarda prospektif olarak yapıldı. KTT olup ileri görüntüleme ihtiyacı olan hastalar önce yatak başı USG ile değerlendirilerek sonuçlar kaydedildi. Daha sonra hastalara supin ön-arka akciğer grafisi (SÖAAG) ve toraks Bilgisayarlı Tomografisi (BT) çekildi. Elde edilen bulguların istatistiksel analizi yapıldı.

Bulgular: Çalışmaya 100’ü (%80.6) erkek, 24’ü (%19.4) kadın toplam 124 hasta dahil edildi. Toraks BT ile karşılaştırıldığında pnömotoraks için; USG’nin duyarlılığı %84.2, özgüllüğü %100, pozitif tahmin değeri %100, negatif tahmin değeri %93.5, hemotoraks için; USG’nin duyarlılığı %92.6, özgüllüğü %100, pozitif tahmin değeri %100, negatif tahmin değeri %98, kosta kırıkları için; USG’nin duyarlılığı %89.8, özgüllüğü %96.9, pozitif tahmin değeri %96.4, negatif tahmin değeri %91.3 idi. Tüm gruplarda USG nin duyarlılığı SÖAAG’den daha fazlaydı.

Sonuç: Çalışmamızda KTT olan erişkinlerde hasta başı yapılan USG’nin pnömotoraks ve hemotoraks tespit etmede altın standard olarak kabul edilen toraks BT’nin olmadığı, ulaşımının zor olduğu veya hastanın toraks BT’ye götürülmesinin uygun olmadığı durumlarda yüksek duyarlılığa sahip, çok değerli bir alternatif olduğunu düşünüyoruz. 

Keywords

• Ultrasonografi
• Pnömotoraks
• Hemotoraks

EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA

Abstract

Objective: We aimed to determine the effectiveness and appropriate use of ultrasonography (USG) in the diagnosis of pneumothorax, hemothorax, and rib fractures in patients presenting to emergency department with Blunt Chest Trauma (BCT).

Material and Methods: This study was prospectively conducted on patients older than 18 years of age who presented to the Emergency Department of Ankara Training and Research Hospital. Patients with BCT who needed advanced imaging studies were first examined with bedside USG and the results were recorded. Afterwards, patients underwent postero-anterior chest X-Ray (PACXR) and thorax computerized tomography (CT). The data were then statistically analyzed.

Results: A total of 124 patients were enrolled, of which 100 (80.6%) were male. Compared with thorax CT (accepted as the gold standard test), USG had a sensitivity of 84.2%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 93.5%for pneumothorax; a sensitivity of 92.6%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98%for hemothorax; and a sensitivity of 89.8%, a specificity of 96.9%, a positive predictive value of 96.4%, and a negative predictive value of 91.3%for rib fracture. In all groups, USG outperformed PACXR in terms of sensitivity.

Conclusion: Thorax CT is regarded as the gold standard for diagnosing pneumothorax and hemothorax. Our study suggests that, among adults with BCT in settings where thorax CT is not available or difficult-to-access, or when it is not feasible to transfer the patient from emergency department to radiology unit, bedside USG appears as an extremely valuable and highly sensitive alternative to thorax CT.

Keywords

• Ultrasonography
• Pneumothorax
• Hemothorax

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