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Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients

Ali Vafaei, Hamid Reza Hatamabadi, Kamran Heidary, Hosein Alimohammadi, Mohammad Tarbiat



Introduction: Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries. Methods: In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT) scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard. Results: 152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67), were enrolled (77.6% male). Chest CT scan showed pulmonary contusion in 48 (31.6%) patients, hemothorax in 29 (19.1%), and pneumothorax in 55 (36.2%) cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96), 0.86 (95% CI: 0.78‒0.94), and 0.80 (95% CI: 0.736‒0.88), respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87) for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86) for hemothorax, and 0.58 (95% CI: 0.5‒0.67) for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02) and pulmonary contusion (p < 0.001). However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08). Conclusion: The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the thoracic cavity.


Thoracic cavity; wounds and injuries; diagnostic imaging; ultrasonography; radiography


Søreide K. Epidemiology of major trauma. Br J Surg. 2009;96(7):697-8.

Heron M. Deaths: leading causes for 2008. Natl Vital Stat Rep. 2012;60(6):1-94.

Danielsen M, Højgaard L, Kjær A, Fischer BM. Positron emission tomography in the follow-up of cutaneous malignant melanoma patients: a systematic review. Am J Nucl Med Mol Imaging. 2014;4(1):17-28.

Schulze C, Hoppe H, Schweitzer W, Schwendener N, Grabherr S, Jackowski C. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy. Forensic Sci Int. 2013;233(1):90-8.

Esmailian M, Zargarbashi EH, Masoumi B, Karami M. Accuracy of ultrasonography in confirmation of adequate reduction of distal radius fractures. Emergency. 2013;1(1):7-10.

Brenner DJ. Medical imaging in the 21st century—getting the best bang for the rad. N Engl J Med. 2010;362(10):943-5.

Lee J, Kirschner J, Pawa S, Wiener DE, Newman DH, Shah K. Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007. Ann Emerg Med. 2010;56(6):591-6.

Holmes JF, Wisner DH, McGahan JP, Mower WR, Kuppermann N. Clinical prediction rules for identifying adults at very low risk for intra-abdominal injuries after blunt trauma. Ann Emerg Med. 2009;54(4):575-84.

Rodriguez RM, Anglin D, Langdorf MI, et al. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg. 2013;148(10):940-6.

Gentry Wilkerson R, 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):11-7.

Xirouchaki N, Magkanas E, Vaporidi K, et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011;37(9):1488-93.

Cardinale L, Volpicelli G, Lamorte A, Martino J, Veltri A. Revisiting signs, strengths and weaknesses of Standard Chest Radiography in patients of Acute Dyspnea in the Emergency Department. J Thorac Dis. 2012;4(4):398-407.

Ebrahimi A, Yousefifard M, Kazemi HM, et al. Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos. 2014;13(4):29-37.

Rodriguez RM, Hendey GW, Marek G, Dery RA, Bjoring A. A pilot study to derive clinical variables for selective chest radiography in blunt trauma patients. Ann Emerg Med. 2006;47(5):415-8.

Sears BW, Luchette FA, Esposito TJ, et al. Old fashion clinical judgment in the era of protocols: is mandatory chest X-ray necessary in injured patients? J Trauma. 2005;59(2):324-32.

Safari S, Baratloo A, Negida AS, Taheri MS, Hashemi B, Selkisari SH. Comparing the Interpretation of Traumatic Chest X-Ray by Emergency Medicine Specialists and Radiologists. Arch Trauma Res. 2014;3(4):e22189.

Michalke JA. An overview of emergency ultrasound in the United States. World J Emerg Med. 2012;3(2):85-90.

Poletti PA, Kinkel K, Vermeulen B, Irmay F, Unger P-F, Terrier F. Blunt Abdominal Trauma: Should US Be Used to Detect Both Free Fluid and Organ Injuries? . Radiology. 2003;227(1):95-103.

Soldati G, Testa A, Pignataro G, et al. The ultrasonographic deep sulcus sign in traumatic pneumothorax. Ultrasound Med Biol. 2006;32(8):1157-63.

Shojaee M, Faridaalaee G, Yousefifard M, et al. New scoring system for intra-abdominal injury diagnosis after blunt trauma. Chin J Tramatol. 2014;17(1):19-24.

Heydari F, Esmailian M, Dehghanniri M. Diagnostic Accuracy of Ultrasonography in the Initial Evaluation of Patients with Penetrating Chest Trauma. Emergency. 2014;2(2):81-4.

Hyacinthe A-C, Broux C, Francony G, et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012;141(5):1177-83.

Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest. 2008;133(1):204-11.

Roberts DJ, Niven DJ, James MT, Ball CG, Kirkpatrick AW. Thoracic ultrasonography versus chest radiography for detection of pneumothoraces: challenges in deriving and interpreting summary diagnostic accuracy estimates. Crit Care. 2014;18:416.

Liu Y-c, Liu J-h, Fang ZA, et al. Modified shock index and mortality rate of emergency patients. World J Emerg Med. 2012;3(2):114-7.

DOI: https://doi.org/10.22037/emergency.v4i1.9251


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