Year 2019, Volume 21 , Issue 3, Pages 276 - 284 2019-12-31

EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA
Acil Servise Künt Toraks Travması ile Başvuran Hastalarda Pnömotoraks, Kosta Kırıkları ve Hemotoraks’ın Değerlendirilmesinde Ultrasonografinin Etkinliği

Halil ÇETİNKAYA [1] , Yücel YÜZBAŞIOĞLU [2] , Mehmet Akif KARAMERCAN [3] , Yavuz KATIRCI [4] , Meral TANDOĞAN [5] , Figen COŞKUN [6]


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.

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. 

  • 1. Centers for Disease Control and Prevention, National Center for Injury Preventional Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Data 2016. Date of acces: 18 January 2019: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html.
  • 2. Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asdy H et al. Application of ultrasonography and radiography in detection of hemothorax; a systematic review and meta-analysis. Emergrncy (Tehran). 2016;4(3):116-26.
  • 3. Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013;17(5):R208. Doi:10.1186/cc13016. PubMed PMID:24060427.
  • 4. Harris JH, Harris WH. Chest. In: Harris JH, ed. The Radiology of Emergency Medicine. 4th ed. Philadelphia. Lippincott Williams and Wilkins, 2000:497-581.
  • 5. Ebrahimi A, Yousefifard M, Kazemi HM, Rasouli HR, Asady H, Jafari AM et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos. 2014;13(4):29-40.
  • 6. Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Nia KS, Jafari MA et al. Screening performance characteristic of ultrasonography and radiography in detection of pleural effusion: a meta-analysis. Emerg (Tehran). 2016;4(1):1-10.
  • 7. Jones KW. Thoracic trauma. Surg Clin North Am. 1980;60:957-81.
  • 8. Kaya H, Basol N, Ayan M, Altunkas A, Tas U. Evaluation of diagnostic radiation doses due to computorize tomography in adult blunt trauma patients in emergency department. Acta Medica Mediterranea. 2013;3(29):503-8.
  • 9. Leblebici Hİ, Kaya Y, Koçak AH. Göğüs travmalı 302 olgunun analizi. Turkish J Thorac Cardiovasc Surg. 2005;13(4):392-6 10. Tekinbaş C, Eroğlu A, Kürkçüoğlu İC, Türkyılmaz A, Yekeler E, Karaoglanoglu N. Toraks travmaları: 592 olgunun analizi. Ulus Travma Derg. 2003;9(4):275-80.
  • 11. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency deparment. Chest. 2008;133(1):204-11.
  • 12. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care. 2006;10(4):R112.
  • 13. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-9.
  • 14. Stauba LJ, Biscarob RRM, Kaszubowskie E, Mauricic R. Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and hemothorax: A systematic review and meta- analysis. Injury.2018;49(3):457-66.
  • 15. Kirkpatrick AW, Sirois M, Laupland KB, Rowan K, Ball. CG, Hameed SM. Hand-held thoracic sonography for detection post-traumatic pneumothoraces: The Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma. 2004;57(2):288-95.
  • 16. Lichtenstein D, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33(6):1231–8.
  • 17. Lichtenstein D, Meziere G, Biderman P, Gepner A. The ‘lung point’: an ultrasound sing specific to pneumothorax. Intensive Care Med. 2000;26(10):1434-40.
  • 18. Mumtaz U, Zahur Z, Chaudhry MA, Warraich RA. Bedside ultrasonography: a useful tool for traumatic pneumothorax. J Coll Physicians Surg Pak. 2016;26(6):459-62.
  • 19. Brooks A, Davies B, Smethhurst M, Connolly J. Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J. 2004;21(1):44-6.
  • 20. Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29(3):312-6.
  • 21. Sisley AC, Rozycki GS, Ballard RB, Namias N, Salomone JP. Rapid detection of traumatic effusion using surgeon-performed ultrasound. J Trauma. 1998;44(2):291-7.
  • 22. Kara M, Dikmen E, Erdal HH, Simsir I, Kara SA. Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma. Eur J Cardiothorac Surg. 2003;24(4):608-13.
  • 23. Hurley M, Keye G, Hamilton S. Is ultrasound really helpful in the detection of rib fractures. Injury. 2004;35(6)562-6.
Primary Language en
Subjects Health Care Sciences and Services
Published Date 2019/3
Journal Section ART
Authors

Orcid: 0000-0002-8847-6809
Author: Halil ÇETİNKAYA
Institution: Samsun Gazi State Hospital, Emergency Department
Country: Turkey


Orcid: 0000-0002-4622-2456
Author: Yücel YÜZBAŞIOĞLU (Primary Author)
Institution: UNIVERSITY OF HEALTH SCIENCES, ANKARA KEÇİÖREN HEALTH RESEARCH CENTER
Country: Turkey


Author: Mehmet Akif KARAMERCAN
Institution: GAZI UNIVERSITY, FACULTY OF MEDICINE
Country: Turkey


Author: Yavuz KATIRCI
Institution: Keçiöğren Training and Research Hospital, Emergency Medicine Department
Country: Turkey


Author: Meral TANDOĞAN
Institution: Keçiöğren Training and Research Hospital, Emergency Medicine Department
Country: Turkey


Author: Figen COŞKUN
Institution: DOKUZ EYLUL UNIVERSITY
Country: Turkey


Dates

Application Date : December 21, 2018
Acceptance Date : December 15, 2019
Publication Date : December 31, 2019

Bibtex @research article { kutfd500305, journal = {Kırıkkale Üniversitesi Tıp Fakültesi Dergisi}, issn = {1302-3314}, eissn = {2148-9645}, address = {}, publisher = {Kirikkale University}, year = {2019}, volume = {21}, pages = {276 - 284}, doi = {10.24938/kutfd.500305}, title = {EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA}, key = {cite}, author = {Çetinkaya, Halil and Yüzbaşıoğlu, Yücel and Karamercan, Mehmet Akif and Katırcı, Yavuz and Tandoğan, Meral and Coşkun, Figen} }
APA Çetinkaya, H , Yüzbaşıoğlu, Y , Karamercan, M , Katırcı, Y , Tandoğan, M , Coşkun, F . (2019). EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA . Kırıkkale Üniversitesi Tıp Fakültesi Dergisi , 21 (3) , 276-284 . DOI: 10.24938/kutfd.500305
MLA Çetinkaya, H , Yüzbaşıoğlu, Y , Karamercan, M , Katırcı, Y , Tandoğan, M , Coşkun, F . "EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA" . Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 21 (2019 ): 276-284 <https://dergipark.org.tr/en/pub/kutfd/issue/51214/500305>
Chicago Çetinkaya, H , Yüzbaşıoğlu, Y , Karamercan, M , Katırcı, Y , Tandoğan, M , Coşkun, F . "EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA". Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 21 (2019 ): 276-284
RIS TY - JOUR T1 - EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA AU - Halil Çetinkaya , Yücel Yüzbaşıoğlu , Mehmet Akif Karamercan , Yavuz Katırcı , Meral Tandoğan , Figen Coşkun Y1 - 2019 PY - 2019 N1 - doi: 10.24938/kutfd.500305 DO - 10.24938/kutfd.500305 T2 - Kırıkkale Üniversitesi Tıp Fakültesi Dergisi JF - Journal JO - JOR SP - 276 EP - 284 VL - 21 IS - 3 SN - 1302-3314-2148-9645 M3 - doi: 10.24938/kutfd.500305 UR - https://doi.org/10.24938/kutfd.500305 Y2 - 2019 ER -
EndNote %0 Kırıkkale Üniversitesi Tıp Fakültesi Dergisi EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA %A Halil Çetinkaya , Yücel Yüzbaşıoğlu , Mehmet Akif Karamercan , Yavuz Katırcı , Meral Tandoğan , Figen Coşkun %T EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA %D 2019 %J Kırıkkale Üniversitesi Tıp Fakültesi Dergisi %P 1302-3314-2148-9645 %V 21 %N 3 %R doi: 10.24938/kutfd.500305 %U 10.24938/kutfd.500305
ISNAD Çetinkaya, Halil , Yüzbaşıoğlu, Yücel , Karamercan, Mehmet Akif , Katırcı, Yavuz , Tandoğan, Meral , Coşkun, Figen . "EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA". Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 21 / 3 (December 2019): 276-284 . https://doi.org/10.24938/kutfd.500305
AMA Çetinkaya H , Yüzbaşıoğlu Y , Karamercan M , Katırcı Y , Tandoğan M , Coşkun F . EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA. Kırıkkale Üni Tıp Derg. 2019; 21(3): 276-284.
Vancouver Çetinkaya H , Yüzbaşıoğlu Y , Karamercan M , Katırcı Y , Tandoğan M , Coşkun F . EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2019; 21(3): 276-284.
IEEE H. Çetinkaya , Y. Yüzbaşıoğlu , M. Karamercan , Y. Katırcı , M. Tandoğan and F. Coşkun , "EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA", Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 21, no. 3, pp. 276-284, Dec. 2020, doi:10.24938/kutfd.500305