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• W2163302112 abstract "The recent article in CHEST (May 2012) by Hyacinthe et al1Hyacinthe AC Broux C Francony G et al.Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma.Chest. 2012; 141: 1177-1183Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar adds to the body of work supporting the use of point-of-care thoracic ultrasonography in the evaluation of trauma patients. However, the study reports sensitivities for the detection of traumatic pneumothorax and hemothorax that are strikingly lower than those described previously.2Wilkerson RG Stone MB Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.Acad Emerg Med. 2010; 17: 11-17Crossref PubMed Scopus (184) Google Scholar, 3Ma OJ Mateer JR Trauma ultrasound examination versus chest radiography in the detection of hemothorax.Ann Emerg Med. 1997; 29: 312-315Abstract Full Text Full Text PDF PubMed Scopus (136) Google Scholar The authors consider several explanations for this discrepancy, but notably, their criteria for the detection of these lesions may have contributed to the unexpectedly poor accuracy of ultrasonography in this study. In their methods, the authors describe a requirement for the visualization of lung point to make the diagnosis of pneumothorax. However, in prior studies, and in our experience, demonstration of lung point is not required to diagnose pneumothorax in the setting of trauma; the absence of lung sliding alone can be used to diagnose pneumothorax, even if lung point is not visualized. Similarly, the authors' diagnostic criteria for hemothorax may have reduced the sensitivity reported for this injury. They required the presence of the sinusoid sign to make a diagnosis of hemothorax. In contrast, seminal studies of thoracic ultrasonography in trauma have accepted the presence of any pleural fluid as indicative of a hemothorax.3Ma OJ Mateer JR Trauma ultrasound examination versus chest radiography in the detection of hemothorax.Ann Emerg Med. 1997; 29: 312-315Abstract Full Text Full Text PDF PubMed Scopus (136) Google Scholar The authors' conclusion that ultrasonography performs better than supine chest radiography concurs with prior studies, but their data suggest that ultrasound test characteristics are closer to supine radiographs than anticipated. Although thoracic ultrasonography of the trauma patient has limitations, the sensitivities reported for common injuries are not representative of prior work and likely underestimate the accuracy that can be expected with commonly used point-of-care ultrasonography approaches. ResponseCHESTVol. 143Issue 1PreviewWe thank Drs Mackenzie and colleagues for their comments about our recent article in CHEST.1 They expressed concern about the relatively low sensitivities of thoracic ultrasonography in diagnosing pneumothorax, hemothorax, and lung contusion found in the population. This gives us the opportunity to discuss the value of the sensitivity of thoracic ultrasonography. Full-Text PDF" @default.
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• W2163302112 date "2013-01-01" @default.
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• W2163302112 title "Sensitivity of Point-of-Care Ultrasonography for Common Thoracic Injuries" @default.
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• W2163302112 doi "https://doi.org/10.1378/chest.12-1988" @default.
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