Emergency Medicine Sun 10 January 2021 To study the diagnostic characteristics of point of care ultrasound in blunt trauma chest patients
Keywords :  PocusBlunt trauma chestPneumothorax 
Researcher : Ramkumar sreenivasan
Research Guide : Tej prakash sinha
Institution Name : Aiims new delhi


Introduction: Trauma is the leading cause of death, morbidity, hospitalization, and disability in people generally 15-45 years of age. Thoracic injuries constitute a significant contribution around 21% among trauma patients.Computerized tomography (CT) scan is the gold standard diagnostic test performed in chest injury patients, but application of CT in all trauma patients has its own limitations. Point of care ultrasound (POCUS) is now becoming an important modality for initial screening of suspected blunt trauma chest patients.This study is to be carried out in an endeavor to study the diagnostic characteristics of bedside point of care ultrasound in identifying the overall injuries like pneumothorax, hemothorax, lung contusion, rib fractures and sternal fractures caused by blunt chest trauma chest over the gold standard test CT scan. Methodology: In this prospective cross sectional study, 118 number of patients who presented to JPN apex trauma center of AIIMS, New Delhi with suspected blunt trauma to chest were recruited. POCUS was done on all these patients and then they were subjected AP chest X-ray and CECT chest examination. Findings in ultrasound were compared with that of CT scan which is the gold standard and then with chest X-ray using standard statistical tools. Results: Out of the 118 cases, maximum patients were in the age group 18-45 years (68.6%). The mean age of patients was found to be 38.9 ± 3.50 years, males were predominant with 81.3% out of total cases.Rib fractures accounted for highest number among the chest injuries caused by blunt trauma. According to the CT scan, Rib fractures were seen 65.2% of patients, followed by pneumothorax(42.3%), hemothorax(37.2%), lung contusion(20.3%), and sternal fracture which was least common, seen only in 8 cases (6.7%). In pneumothorax, sensitivity and specificity of POCUS came out to be 87.93% [77.12-94.03] and 98.31% [95.16-99.43] respectively. For hemothorax, sensitivity came out to be 68.97% [56.2-79.38] and specificity was 96.07% [92.11-98.08]. For diagnosis of pulmonary contusion by ultrasound over CT, sensitivity came out to be 80% [62.69-90.5], specificity was 96.6% [93.15-98.34], PPV was 77.42% [60.19-88.61] and NPV was 97.07% [93.76-98.65]. For the diagnosis of rib fracture by ultrasound, sensitivity came out to be 54.55% [43.47-65.19], specificity was 95.12% [83.86-98.65]. Finally for diagnosis of sternal fracture, ultrasound picked up 7 out of total 8 sternal fractures found on CT. The sensitivity of the same came out to be 87.5% [52.91-97.76]. The diagnostic characteristics of Chest X-ray were far inferior when compared to ultrasound except for similar results in diagnosis of rib fractures. Conclusion: The results of our study showed that POCUS is far superior to the conventional X-ray and can essentially replace it in the initial evaluation of patients with suspected blunt trauma to the chest. However, its decreased sensitivity when compared to CT scan can be attributed to the patient factors like obesity and other concomitant injury factors like presence of subcutaneous emphysema.

DOI: 1610297551   Year of publication: 2021

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