Value of point-of-care ultrasonography compared with computed tomography scan in detecting potential life-threatening conditions in blunt chest trauma patients

Abstract

Background Ultrasonography is a suitable modality that can potentially improve patient care, saving time and lives. Purpose This article has evaluated the caveats and pitfalls of point-of-care ultrasonography in the diagnosis of pneumothorax, hemothorax and contusion. Materials and methods This prospective study was performed in 157 patients with blunt chest trauma in 3 university hospitals. Ultrasonography was performed by 2 board-certified emergency medicine specialists and an emergency medicine resident PGY-3 after passing the training process successfully. Results The false-negative cases were not significantly correlated with accompanying traumatic injuries. Lung ultrasonography accompanied by chest physical examination show accuracy 91.8. Point-of-care ultrasonography (PoCUS) showed sensitivity 75.0%, specificity 100%, positive-predictive value (PPV) of 100% and a negative-predictive value (NPV) of 94.9% for the diagnosis of pneumothorax. For hemothorax, bedside PoCUS had a sensitivity of 45.4%, specificity of 100%, PPV of 100% and NPV of 91.8%. PoCUS was assessed 58.1% sensitive and 100% specific for detecting lung contusion with positive-predictive value (PPV) of 100% and a negative-predictive value (NPV) of 86.3%. Performing US resulted in no false-positive cases. Conclusions Point-of-care ultrasonography was highly sensitive to detect pneumothorax and can be beneficial for the disposition of stable patients and to detect PTX in unstable patients before transferring to the operating room. It is also moderately appropriate for the diagnosis of hemothorax and lung contusion compared to the gold standard, CT scan. It is essential to consider the false-negative and false-positive instances of lung ultrasound in various situations to enhance management and disposition of blunt thoracic injuries.