Diagnostic Accuracy of Bedside Lung Ultrasound in Detecting Traumatic Pneumothorax by Novice Physicians in the Emergency Department of a Tertiary Care Hospital of Nepal

TL;DR

This study shows that trained novice doctors can accurately use lung ultrasound to detect traumatic pneumothorax in emergency settings, matching the accuracy of chest X-rays.

Contribution

The study demonstrates the diagnostic accuracy of bedside lung ultrasound performed by novice physicians in a resource-limited setting.

Findings

Lung ultrasound had 100% sensitivity and 97.75% specificity in detecting traumatic pneumothorax.

LUS accuracy was comparable to supine chest X-rays and other diagnostic methods.

LUS is portable, repeatable, and reduces radiation exposure.

Abstract

Traumatic pneumothorax is a life-threatening condition requiring vigilant clinical assessment and urgent management. Lung ultrasound (LUS) is considered to be a safer, rapid, and accurate modality for the early diagnosis of traumatic pneumothorax. The principle objective of this study was to evaluate the diagnostic accuracy of bedside LUS performed by trained novice physicians in the diagnosis of traumatic pneumothorax as compared to supine chest X-rays (CXRs) and/or computed tomography (CT) scans and/or air leak during needle/tube thoracostomy as composite standard.

It is a prospective, cross-sectional, single-blinded study using a nonprobability quota sampling technique. A total of 96 patients presenting to the emergency department (ED) with polytrauma and chest injuries within a period of twelve months were included. The diagnostic accuracy of bedside LUS performed by trained novice physicians was calculated in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared with the composite standard.

The sensitivity of LUS in diagnosing traumatic pneumothorax as compared to the composite standard was 100% (95% confidence interval (CI): 59.05%–100.00%), whereas its specificity was 97.75% (95% CI: 92.12%–99.73%). Similarly, the PPV and NPV of LUS were 77.7% (95% CI: 39.99%–97.19%) and 100% (95% CI: 95.85%–100.00%), respectively.

The results of the study showed that the application of LUS in detecting traumatic pneumothorax had similar diagnostic accuracy as supine CXR. Bedside LUS is widely available, portable, and inexpensive. It also has the capability of real-time imaging and can be repeated as necessary with less risk of radiation exposure. Therefore, physicians working in tertiary and rural health institutions must be trained adequately in order to uplift the clinical utility of LUS for the timely and cost-effective detection of traumatic pneumothorax.

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