急诊部即时超声诊断严重创伤患者临床显著性气胸的准确性

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-07-17 DOI:10.1016/j.jemermed.2025.07.009

Daniel D. Singer MD , Hayley Scott MD , Ali Khan MD , Alexandra Donnelly DO , Adam J. Singer MD , Isadora Botwinick MD , Randeep Jawa MD , Ambika Mukhi MS , Henry C. Thode MD , Michael Secko MD

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引用次数: 0

摘要

背景：与仰卧位胸部x线（CXR）研究相比，胸部即时超声（POCUS）是一种检测气胸（PTX）的改进方式，具有较高的准确性。然而，最近的研究质疑POCUS对创伤患者PTX诊断的敏感性。目的根据2021年美国国家现场分诊专家小组（National Expert Panel on Field Triage）的红色标准，确定急诊医师（EP） POCUS识别高严重创伤患者临床显著PTX的准确性。方法回顾性分析某一级创伤中心3年来收治的严重创伤患者。PTX的存在与否是通过计算机断层扫描或临床医生对胸腔插管放置时“空气涌动”的描述来确定的。如果患者在分诊后2.5小时内需要插管开胸手术，则PTX被定义为具有临床意义。计算急诊人员进行的CXR研究和POCUS的诊断试验特征。结果924例患者中有40例有明显临床意义的PTX。POCUS在计算机断层扫描前确定了38例患者中的26例，敏感性为68% (95% CI 52-80%)，特异性为100% (95% CI 19.8-100%)，阳性预测值为100% (95% CI 84-100%)，阴性预测值为14.3% （95% CI 2.5-43.9%）。通过奖学金培训的EPs对POCUS进行回顾，38例中有32例的敏感性提高（84%;95% CI 70-93%），特异性保持不变，PPV为100% (95% CI 87-100%)， NPV为25% （95% CI 4.5-64%）。普通CXR研究的总敏感性为48.1% (95% CI 34.2 ~ 62.2%)，特异性为99% （95% CI 97.5 ~ 99.6%）。结论POCUS能够准确识别临床意义上的PTX，特别是在接受过培训的EPs的指导下。经验不足的EPs应在图像采集和解释方面运用适当的技术，并可能需要训练有素的EPs更多的监督。这些结果突出了持续实时质量改进的必要性。

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Emergency Department Accuracy of Point-of-Care Ultrasound in Identifying Clinically Significant Pneumothorax in High-Severity Trauma Patients

Background

Thoracic point-of-care ultrasound (POCUS) is an improved modality for detecting pneumothorax (PTX) with high accuracy compared with supine chest x-ray (CXR) study. However, recent research has questioned the sensitivity of POCUS for diagnosis of PTX in trauma patients.

Objective

The authors determined the accuracy of emergency physician (EP) POCUS in identifying clinically significant PTX in high-severity trauma patients based on the red criteria of the 2021 National Expert Panel on Field Triage.

Methods

The authors conducted a retrospective review of high-severity trauma patients over a 3-year period at a level I trauma center. The presence or absence of PTX was determined by means of computed tomography or a clinician’s description of a “rush of air” on tube thoracostomy placement. PTX was defined as clinically significant if the patient required tube thoracostomy within 2.5 h of triage. Diagnostic test characteristics of CXR study and POCUS performed by emergency providers were calculated.

Results

Forty of 924 patients had clinically significant PTX. POCUS identified 26 of 38 patients who survived before computed tomography, for a sensitivity of 68% (95% CI 52–80%), specificity of 100% (95% CI 19.8–100%), positive predictive value of 100% (95% CI 84–100%), and negative predictive value of 14.3% (95% CI 2.5–43.9%). Review of POCUS by fellowship-trained EPs improved sensitivity to 32 of 38 (84%; 95% CI 70–93%), specificity remained the same, PPV was 100% (95% CI 87–100%), and NPV was 25% (95% CI 4.5–64%). Plain CXR study had an overall sensitivity of 48.1% (95% CI 34.2–62.2%) and specificity of 99% (95% CI 97.5–99.6%).

Conclusions

Our results suggest that POCUS is accurate in identifying clinically significant PTX, especially when supervised by fellowship-trained EPs. Less experienced EPs should exercise proper technique in image acquisition and interpretation and may require more supervision by trained EPs. These results highlight the necessity for ongoing real-time quality improvement.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine