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Correspondence |

Sensitivity of Point-of-Care Ultrasonography for Common Thoracic InjuriesUltrasonography in Thoracic Trauma FREE TO VIEW

David C. Mackenzie, MD, CM; Andrew S. Liteplo, MD; Vicki E. Noble, MD
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From the Department of Emergency Medicine, Massachusetts General Hospital.

Correspondence to: David C. Mackenzie, MD, CM, Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St, Zero Emerson Pl, Ste 3B, Boston, MA 02114; e-mail: dcmackenzie@partners.org


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Chest. 2013;143(1):269a. doi:10.1378/chest.12-1988
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To the Editor:

The recent article in CHEST (May 2012) by Hyacinthe et al1 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.2,3 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.3

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.

References

Hyacinthe AC, Broux C, Francony G, et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012;141(5):1177-1183. [CrossRef] [PubMed]
 
Wilkerson 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(1):11-17. [CrossRef] [PubMed]
 
Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29(3):312-315. [CrossRef] [PubMed]
 

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References

Hyacinthe AC, Broux C, Francony G, et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012;141(5):1177-1183. [CrossRef] [PubMed]
 
Wilkerson 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(1):11-17. [CrossRef] [PubMed]
 
Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29(3):312-315. [CrossRef] [PubMed]
 
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