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

Yıl 2019, Cilt: 21 Sayı: 3, 276 - 284, 31.12.2019

Halil Çetinkaya Yücel Yüzbaşıoğlu , Mehmet Akif Karamercan Yavuz Katırcı Meral Tandoğan , Figen Coşkun

https://doi.org/10.24938/kutfd.500305

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

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

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

Ultrasonography, Pneumothorax, Hemothorax

Kaynakça

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