Acil Servise Künt Toraks Travması ile Başvuran Hastalarda Pnömotoraks, Kosta Kırıkları ve Hemotoraks’ın Değerlendirilmesinde Ultrasonografinin Etkinliği
Öz
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.
Anahtar Kelimeler
Kaynakça
- 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.
EFFECTIVENESS OF ULTRASONOGRAPHY IN IMAGING ASSESSMENT OF PNEUMOTHORAX, RIB FRACTURES, AND HEMOTHORAX IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH BLUNT CHEST TRAUMA
Öz
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.
Anahtar Kelimeler
Kaynakça
- 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.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | MAK |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Aralık 2019 |
| Gönderilme Tarihi | 21 Aralık 2018 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 21 Sayı: 3 |
Kaynak Göster
Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.