Objectives: Historically, chest radiograph (CXR) has been used to quickly diagnose pneumothorax and hemothorax in trauma patients. Over the last decade, lung ultrasound on extended Focused Assessment with Sonography in Trauma (eFAST) has also been described as a modality for diagnosing pneumothorax in trauma patients. Both eFAST lung view and CXR are used for most level 1 and 2 traumas at our institution. We compared pneumothorax detection using both CXR and ultrasonography.
Methods: We queried our institution’s trauma databases for all trauma team activations from January 1, 2021, to December 31, 2021. The following data points were tracked: eFAST, initial chest radiography, computerized tomography (CT) scan results, and received a chest tube within 24 hours of hospital arrival. We compared pneumothorax detection rates on initial CXR to those diagnosed on eFAST. True positive results were defined as 1) patients who received a chest tube and had a positive eFAST or CXR and 2) patients with a pneumothorax on the first CT scan and a pneumothorax eFAST lung view or CXR.
Results: There were 2,008 traumas at our center in 2021. 550 patients were included in the analysis after excluding patients with an indeterminate pneumothorax diagnosis on initial CXR or lung view on eFAST and those without an ultrasound and chest radiograph. 54 patients received a chest tube, of which 43.1% had a positive eFAST lung view, and 37.3% had a pneumothorax on CXR. Of the patients who did not receive a chest tube, only 1.7% had a false positive eFAST, and 1.2% had a false positive CXR. Of patients with a pneumothorax on CT scan, 22.7% had a positive eFAST lung view, and 18.4% had a pneumothorax on initial CXR. Only 0.5% of patients had a false positive eFAST.
Conclusion: eFAST lung view and CXR were comparable in predicting the need for a chest tube in the first 24 hours of admission and the presence of a pneumothorax on a CT scan. This suggests that ultrasound may be as accurate as CXR in detecting a large pneumothorax. Moreover, if both studies are comparable, we believe lung ultrasound should be considered for use instead of CXR quickly diagnosing pneumothorax in the bay as it is faster and does not expose patients and the trauma team to radiation.
