Application of Ultrasonography and Radiography in Detection of Hemothorax: a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 4 No. 3 (2016),
1 August 2016
,
Page 116-126
https://doi.org/10.22037/aaem.v4i3.234
Abstract
Introduction: Hemothorax is one of the most prevalent injuries caused by thoracic traumas. Early detection and treatment of this injury is of utmost importance in prognosis of the patient, but there are still controversial debates on the diagnostic value of imaging techniques in detection of hemothorax. Therefore, the present study aimed to evaluate the diagnostic value of chest ultrasonography and radiography in detection of hemothorax through a systematic review and meta-analysis. Methods: Two independent reviewers performed an extended systematic search in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. Data were extract and quality of the relevant studies were assessed. The number of true positive, false positive, true negative and false negative cases were extracted and screening performance characteristics of two imaging techniques were calculated using a mixed-effects binary regression model. Results: Data from 12 studies were extracted and included in the meta-analysis (7361 patients, 77.1% male). Pooled sensitivity and specificity of ultrasonography in detection of hemothorax were 0.67 (95% CI: 0.41-0.86; I2= 68.38, p<0.001) and 0.99 (95% CI: 0.95-1.0; I2= 88.16, p<0.001), respectively. These measures for radiography were 0.54 (95% CI: 0.33-0.75; I2= 92.85, p<0.001) and 0.99 (95% CI: 0.94-1.0; I2= 99.22, p<0.001), respectively. Subgroup analysis found operator of the ultrasonography device, frequency of the transducer and sample size to be important sources of heterogeneity of included studies. Conclusion: The results of this study showed that although the sensitivity of ultrasonography in detection of hemothorax is relatively higher than radiography, but it is still at a moderate level (0.67%). The specificity of both imaging modalities were found to be at an excellent level in this regard. The screening characteristics of ultrasonography was found to be influenced of the operator and frequency of transducer.- Hemothorax
- ultrasonography
- radiography
- diagnostic tests
- routine
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References
Hill A, Fowler R, Pinto R, Nathens A. Epidemiology of major trauma: a Canadian perspective. Can J Surg. 2011;54(3):S45.
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.
Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg. 2001;67(7):660.
Tocino I, Miller MH. Computed tomography in blunt chest trauma. J Thorac Imaging. 1987;2(3):45-59.
Trupka A, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma. 1997;43(3):405-11.
Brenner DJ. Medical imaging in the 21st century—getting the best bang for the rad. The New England journal of medicine. 2010;362(10):943-5.
Brenner DJ, Hall EJ. Computed tomography -an increasing source of radiation exposure. N Engl J Med. 2007;357:2277-84.
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.
Exadaktylos AK, Sclabas G, Schmid SW, Schaller B, Zimmermann H. Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with “normal†chest radiograph? Journal of Trauma-Injury, Infection, and Critical Care. 2001;51(6):1173-6.
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.
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.
Bokhari F, Brakenridge S, Nagy K, et al. Prospective evaluation of the sensitivity of physical examination in chest trauma. Journal of Trauma-Injury, Infection, and Critical Care. 2002;53(6):1135-8.
Forouzanfar MM, Safari S, Niazazari M, et al. Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas. Emerg Med Australas. 2014;26(6):561-6.
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.
Michalke JA, Rocovich C, Patel T, et al. An overview of emergency ultrasound in the United States. World. 2012;3(2):85-90.
Brooks A, Davies B, Smethhurst M, Connolly J. Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J. 2004;21(1):44-6.
Hyacinthe A-C, Broux C, Francony G, et al. Diagnostic Accuracy of Ultrasonography in the Acute Assessment of Common Thoracic Lesions After TraumaUltrasonography in Thoracic Trauma. Chest. 2012;141(5):1177-83.
Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG. Occult Traumatic PneumothoraxDiagnostic Accuracy of Lung Ultrasonography in the Emergency Department. Chest. 2008;133(1):204-11.
Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG. Chest ultrasonography in lung contusion. Chest. 2006;130(2):533-8.
Zhang M, Liu Z-H, Yang J-X, et al. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Critical Care. 2006;10(4):R112.
McGahan JP, Wang L, Richards JR. From the RSNA Refresher Courses Focused Abdominal US for Trauma. Radiographics. 2001;21(suppl 1):S191-S9.
Poletti PA, Kinkel K, Vermeulen B, Irmay F, Unger PF, Terrier F. Blunt Abdominal Trauma: Should US Be Used to Detect Both Free Fluid and Organ Injuries? . Radiology. 2003;227(1):95-103.
Poletti PA, Mirvis SE, Shanmuganathan K, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma Acute Care Surg. 2004;57(5):1072-81.
Meyer DM. Hemothorax related to trauma. Thorac Surg Clin. 2007;17(1):47-55.
Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29(3):312-6.
Abboud P-AC, Kendall J. Emergency department ultrasound for hemothorax after blunt traumatic injury. J Emerg Med. 2003;25(2):181-4.
Ebrahimi A, Yousefifard M, Mohammad Kazemi H, et al. Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos. 2014;13(4):29-40.
Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Critical Care. 2013;17(5):R208.
Traub M, Stevenson M, McEvoy S, et al. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury. 2007;38(1):43-7.
suárez Poveda T, Uribe CHM, Loaiza JR, Hurtado ÉHO, RodrÃguez JPL, valencia Delgado AM. Chest Ultrasonography versus Chest CT for Diagnosis of posttraumatic residual hemothorax. Rev Colomb Radiol. 2012;23(2):3464-8.
Błasińska-Przerwa K, Pacho R, Bestry I. Pneumonol Alergol Pol. Pneumonologia Alergologia Polska. 2013;81(6):518-26.
Uz I, Yuruktumen A, Boydak B, et al. Impact of the practice of "Extended Focused Assessment with Sonography for Trauma" (e-FAST) on clinical decision in the emergency department. Turk J Trauma Emerg Surg. 2013;19(4):327-32.
Chardoli M, Hasan-Ghaliaee T, Akbari H, Rahimi-Movaghar V. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma. Chin J Traumatol. 2013;16(6):351-4.
Leblanc D, Bouvet C, Degiovanni F, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med. 2014;40(10):1468-74.
Langdorf MI, Medak AJ, Hendey GW, et al. Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study. Ann Emerg Med. 2015.
Vafaei A, Hatamabadi HR, Heidary K, Alimohammadi H, Tarbiat M. Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients. Emergency. 2015;3:[In press].
Sistrom CL, Mergo PJ. A simple method for obtaining original data from published graphs and plots. Am J Roentgenol. 2000;174(5):1241-4.
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529-36.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557.
Majumdar S, Kumar PS, Pandit A. Effect of liquid-phase properties on ultrasound intensity and cavitational activity. Ultrason Sonochem. 1998;5(3):113-8.
Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882-93.
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