Initial assessment of chest X-ray in thoracic trauma patients: Awareness of specific injuries

Background: The emergency department usually takes a supine posteroanterior (PA) chest X-ray imaging in trauma patients. In some cases, pneumothorax is not seen in the chest X-ray because of the patient's position. These cases are called occult pneumothorax. Misdiagnosis of occult pneumothorax in the emergency department may lead to complications such as tension pneumothorax. This study aimed to update patients’ features with occult pneumothorax due to blunt or penetrating trauma. Methods: In this study, data of 615 thoracic trauma patients admitted to the emergency department between January 2008 and December 2010 were evaluated. In total, 157 patients had undergone both chest X-ray and chest computed tomography and were diagnosed with pneumothorax. Of the 157 patients, 52 were excluded due to some criteria. Data of 105 patient, including their characteristics, trauma types, accompanying traumas, etiology of the chest trauma, chest X-ray findings, and computed chest tomography results were recorded. Data obtained were compared with the results of similar studies conducted in the last 10 years. Chest computed tomography was considered the gold standard for the diagnosis of pneumothorax. Results: The mean patient age was 36.19 ± 14.74 years. Occult pneumothorax was detected in 8 of 105 patients, giving a 7.6% overall incidence of occult pneumothorax. A traffic accident was the most common cause of etiology. All occult pneumothorax cases were caused by blunt trauma, and tube thoracostomy was performed in all of them. No significant differences were found between pneumothorax and occult pneumothorax cases concerning the etiology, accompanied trauma, intervention types, and trauma reasons (p < 0.05). Conclusions: This study supports the incidence of occult pneumothorax reported in the literature. When a patient is admitted with thoracic trauma, a physician should carefully evaluate the patient through supine chest X-ray examination. Only one misdiagnosis in trauma patients can be lead to many unintentional clinical and forensic results.

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LUNG ULTRASOUND DURING COVID-19 PANDEMICS: WHY, HOW AND WHEN?

Wiadomości Lekarskie ◽

10.36740/wlek202108101 ◽

2021 ◽

Vol 74 (8) ◽

pp. 1783-1788

Author(s):

Khrystyna O. Pronyuk ◽

Liudmyla O. Kondratiuk ◽

Andrii D. Vysotskyi ◽

Olga A. Golubovska ◽

Iryna M. Nikitina

Keyword(s):

Hospital Stay ◽

Clinical Decision Making ◽

Lung Ultrasound ◽

Limited Resource ◽

Clinical Decision ◽

Lung Damage ◽

Dynamic Monitoring ◽

Initial Assessment ◽

X Ray ◽

Chest X Ray

The aim: To optimize diagnostic of pathological processes in lungs affected by COVID-19, dynamic monitoring and clinical decision making using lung ultrasound in limited resources settings. Materials and methods: Between the onset of pandemics and January 2021, approximately 9000 patients have been treated for confirmed COVID-19 in the Olexandrivska Clinical Hospital. Assessment of all hospitalized patients included hematology, chemistries and proinflammatory cytokines – IL-6, CRP, procalcitonin, ferritin. Diagnosis was confirmed by PCR for SARS-CoV-2 RNA. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. Lung ultrasound was proactively utilized to assess the type and extent of lung damage and to monitor the progress of disease in patients hospitalized into the ICU and Infection Unit (n=135). Ultrasound findings were recorded numerically based on scales. Results: In the setting of СOVID-19, bedside lung ultrasound has been promptly recognized as a tool to diagnose and monitor the nature and extent of lung injury. Lung ultrasound is a real time assessment, which helps determine the nature of a pathologic process affecting lungs. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. Described in article data is collected in one of the biggest facility that deals with COVID-19. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. The cases presented in the paper indicate potential advantages to the use of ultrasound in limited resource healthcare settings, especially when the risk of transportation to CT outweighs the value of information obtained. Conclusions: Grading of ultrasonographic findings in the lungs was sufficient for both initial assessment with identification of high risk patients, and routine daily monitoring. Hence, lung ultrsound may be used to predict deterioration, stratify risks and make clinical decisions.

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Chest X-ray as a screening tool for blunt thoracic trauma in children

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/1757-7241-21-s1-s8 ◽

2013 ◽

Vol 21 (S1) ◽

Author(s):

NL Yanchar ◽

K Woo ◽

M Brennan ◽

C Palmer ◽

M Ee ◽

...

Keyword(s):

Thoracic Trauma ◽

Screening Tool ◽

Blunt Thoracic Trauma ◽

X Ray ◽

Chest X Ray

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08. Missed Diagnosis of Pneumothorax During Aeromedical Transport

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00045829 ◽

1996 ◽

Vol 11 (S2) ◽

pp. S38-S38

Author(s):

SH Thomas ◽

P DeVellis ◽

T Harrison ◽

SK Wedel

Keyword(s):

Trauma Center ◽

Air Transport ◽

Trauma Patients ◽

X Ray ◽

Chest X Ray ◽

Missed Diagnosis ◽

Level I ◽

Aeromedical Transport ◽

One Year ◽

Needle Decompression

Purpose: Difficulties with physical assessment inherent to the helicopter environment have led to suggestion that aeromedical crews may be unable to identify hemo- or pneumothorax (HTX/PTX) while in-flight. This study was conducted to determine the frequency of missed HTX/PTX in trauma patients undergoing air transport.Methods: One year (1994) of an air medical service's trauma transports to a Level I trauma center were analyzed to identify patients undergoing tube thoracostomy (TT) within 2 hours of trauma center arrival. Patients who had received intra-transport needle thoracostomy were excluded. Records were reviewed to determine how HTX/PTX was diagnosed at the trauma center.Results: Only 11 patients who had not received aeromedical needle decompression underwent TT at the receiving center. Two of the 11 were trauma arrests and received TT as part of thoracotomy, without air or blood return on TT. None of the remaining 9 patients had TT on clinical suspicion alone. Four had normal physical examination and underwent TT after chest X-ray (CXR). Remaining patients had no HTX/PTX clues on exam or CXR; one had a small HTX identified on chest computed tomography and the other four received intra-operative TT because of rib fractures in the setting of multisystem trauma.

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Ultrasound Detection of Pneumothorax Compared with Chest X-Ray and Computed Tomography Scan

The American Surgeon ◽

10.1177/000313481107700427 ◽

2011 ◽

Vol 77 (4) ◽

pp. 480-483 ◽

Cited By ~ 29

Author(s):

Khanjan Nagarsheth ◽

Stanley Kurek

Keyword(s):

Ct Scan ◽

Negative Predictive Value ◽

Predictive Value ◽

Chest Ct ◽

Trauma Patients ◽

X Rays ◽

Thoracic Ultrasound ◽

X Ray ◽

Chest X Ray ◽

Chest Ct Scan

Pneumothorax after trauma can be a life threatening injury and its care requires expeditious and accurate diagnosis and possible intervention. We performed a prospective, single blinded study with convenience sampling at a Level I trauma center comparing thoracic ultrasound with chest X-ray and CT scan in the detection of traumatic pneumothorax. Trauma patients that received a thoracic ultrasound, chest X-ray, and chest CT scan were included in the study. The chest X-rays were read by a radiologist who was blinded to the thoracic ultrasound results. Then both were compared with CT scan results. One hundred and twenty-five patients had a thoracic ultrasound performed in the 24-month period. Forty-six patients were excluded from the study due to lack of either a chest X-ray or chest CT scan. Of the remaining 79 patients there were 22 positive pneumothorax found by CT and of those 18 (82%) were found on ultrasound and 7 (32%) were found on chest X-ray. The sensitivity of thoracic ultrasound was found to be 81.8 per cent and the specificity was found to be 100 per cent. The sensitivity of chest X-ray was found to be 31.8 per cent and again the specificity was found to be 100 per cent. The negative predictive value of thoracic ultrasound for pneumothorax was 0.934 and the negative predictive value for chest X-ray for pneumothorax was found to be 0.792. We advocate the use of chest ultrasound for detection of pneumothorax in trauma patients.

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Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients

World Journal of Emergency Surgery ◽

10.1186/s13017-019-0287-5 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Gregory J. Roberts ◽

Lewis E. Jacobson ◽

Michelle M. Amaral ◽

Courtney D. Jensen ◽

Louis Cooke ◽

...

Keyword(s):

Blunt Trauma ◽

Chest Ct ◽

Physical Exam ◽

Trauma Patients ◽

Cross Sectional ◽

X Ray ◽

Cross Sectional Imaging ◽

Normal Chest ◽

Chest X Ray ◽

Sectional Imaging

Abstract Background High morbidity and mortality rates of trauma injuries make early detection and correct diagnosis crucial for increasing patient’s survival and quality of life after an injury. Improvements in technology have facilitated the rapid detection of injuries, especially with the use of computed tomography (CT). However, the increased use of CT imaging is not universally advocated for. Some advocate for the use of selective CT imaging, especially in cases where the severity of the injury is low. The purpose of this study is to review the CT indications, findings, and complications in patients with low Injury Severity Scores (ISS) to determine the utility of torso CT in this patient cohort. Methods A retrospective review of non-intubated, adult blunt trauma patients with an initial GCS of 14 or 15 evaluated in an ACS verified level 1 trauma center from July 2012 to June 2015 was performed. Data was obtained from the hospital’s trauma registry and chart review, with the following data included: age, sex, injury type, ISS, physical exam findings, all injuries recorded, injuries detected by torso CT, missed injuries, and complications. The statistical tests conducted in the analysis of the collected data were chi-squared, Fischer exact test, and ANOVA analysis. Results There were 2306 patients included in this study, with a mean ISS of 8. For patients with a normal chest exam that had a chest CT, 15% were found to have an occult chest injury. In patients with a negative chest exam and negative chest X-ray, 35% had occult injuries detected on chest CT. For patients with a negative abdominal exam and CT abdomen and pelvis, 16% were found to have an occult injury on CT. Lastly, 25% of patients with normal chest, abdomen, and pelvis exams with chest, abdomen, and pelvis CT scans demonstrated occult injuries. Asymptomatic patients with a negative CT had a length of stay 1 day less than patients without a corresponding CT. No incidents of contrast-induced complications were recorded. Conclusions A negative physical exam combined with a normal chest X-ray does not rule out the presence of occult injuries and the need for torso imaging. In blunt trauma patients with normal sensorium, physical exam and chest X-ray, the practice of obtaining cross-sectional imaging appears beneficial by increasing the accuracy of total injury burden and decreasing the length of stay.

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eFAST for Pneumothorax: Real-Life Application in an Urban Level 1 Center by Trauma Team Members

The American Surgeon ◽

10.1177/000313481808400228 ◽

2018 ◽

Vol 84 (2) ◽

pp. 220-224 ◽

Cited By ~ 3

Author(s):

Steven Maximus ◽

Cesar Figueroa ◽

Matthew Whealon ◽

Jacqueline Pham ◽

Eric Kuncir ◽

...

Keyword(s):

Real Life ◽

Standard Of Care ◽

Trauma Team ◽

Tube Thoracostomy ◽

Trauma Patients ◽

Team Members ◽

X Ray ◽

Chest X Ray ◽

Level 1 ◽

Clinically Significant

The focused assessment with sonography for trauma (FAST) examination has become the standard of care for rapid evaluation of trauma patients. Extended FAST (eFAST) is the use of ultra-sonography for the detection of pneumothorax (PTX). The exact sensitivity and specificity of eFAST detecting traumatic PTX during practical “real-life” application is yet to be investigated. This is a retrospective review of all trauma patients with a diagnosis of PTX, who were treated at a large level 1 urban trauma center from March 2013 through July 2014. Charts were reviewed for results of imaging, which included eFAST, chest X-ray, and CT scan. The requirement of tube thoracostomy and mechanism of injury were also analyzed. A total of 369 patients with a diagnosis of PTX were identified. A total of 69 patients were excluded, as eFASTwas either not performed or not documented, leaving 300 patients identified with PTX. A total of 113 patients had clinically significant PTX (37.6%), requiring immediate tube thoracostomy placement. eFAST yielded a positive diagnosis of PTX in 19 patients (16.8%), and all were clinically significant, requiring tube thoracostomy. Chest X-ray detected clinically significant PTX in 105 patients (92.9%). The literature on the utility of eFAST for PTX in trauma is variable. Our data show that although specific for clinically significant traumatic PTX, it has poor sensitivity when performed by clinicians with variable levels of ultrasound training. We conclude that CT is still the gold standard in detecting PTX, and clinicians performing eFAST should have adequate training.

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