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Background:Portable bed side ultrasound and supine chest radiograph of 80 traumaticpatients excluding very clinically unstable patients who subsequently underwent CTscan chest was done for traumatic effusion showing that ultrasound had a higher sensitivity than CXR, 88.23% and 77.94%, respectively, and a similar specificity of 100% and 100%, respectively. Objective of the study is to compare the diagnostic accuracy of high resolution ultrasound and supine chest x-ray in detection of pleural effusion in road traffic accident patients keeping plain CT chest as gold standard. Methods:Thisstudy was conducted inPIMS and PAEC General Hospital, Islamabad from 1stJanuary to 15th December 2015.The current study examined total of 80 trauma (blunt and penetrating) patients coming to emergency departments of bothhospitals specifically those who had road traffic accident history. Their portable bed side ultrasound and supine chest radiograph were performed for assessing pleural effusion and subsequently CT scan chest was done for confirmation as it’s a gold standard.Results:Using CT findings as gold standard the sensitivity, specificity, positive predictive value and negative predictive value was assessed for both ultrasonography and chest radiography and found to be 88.23%,100%, 100%, 40% and 77.94%, 100%, 100%, 55.55% respectively with diagnostic accuracy of ultrasound 90% as compared to 81.25% for supine chest x-rays when compared with gold standard.Conclusion:Ultrasound and chest x-ray can be used as a useful and suitable adjunct to CT in road traffic accident patients as these are easily available, non-invasive, no contrast required, can be performed on bed side and carries no or little radiation risk.Keywords:Ultrasound; Chest x-ray; Computed tomography; Road traffic accident; TraumaJ Ayub Med Coll Abbottabad 2017;29(4):587–90INTRODUCTIONThoracic injuries are significant causes of morbidity and mortality in trauma patients. These injuries account for approximately 25% of trauma-related deaths in the United States, second only to head injuries. Road Traffic Accident (RTA) was found to be the commonest cause of Blunt Chest Trauma (90%) while Gunshot injuries constituted the commonest cause of Penetrating Chest Trauma (73%). Radiologic imaging plays an important role in the diagnosis and management of blunt chest trauma.1Ultrasound evaluation for these road traffic accident traumatic patients as FAST (Focused Assessment with Sonography for Trauma) is considered as initial step in management.2,3 Studies have assessed important characteristics of ultrasound for detecting significant traumatic hemothoraces.4,5In addition to common traumatic thoracic injury, it also identifies complications of blunt trauma5 and free fluid of >200ml is usually detected by this imaging modality4,6,7.Ultrasound has high sensitivity and specificity of 92% and 100% respectively with positive predictive value of 100% and negative predictive value 98% for traumatic hemothorax.4,8Ultrasound is portable, inexpensive, free of ionizing radiation, and allows the clinician to perform examinations rapidly and repeatedly to obtain diagnostic information at the bedside.2,9 Ultrasound provides an important initial screening examination in the adult trauma patient. However, it is not a replacement for the more sensitive imaging studies like CT. Costophrenic area assessed as part of the FAST examination is the site in supine patient where free intrathoracic fluid accumulates.The chest radiograph (CXR) is the initial test for all patients with blunt thoracic trauma.10 It is inexpensive, noninvasive, easy to obtain, and in many instances, reveals useful information so it must be performed in all stable patients who have sustained blunt thoracic trauma. A volume of 300 mL is needed for hemothorax to manifest on an upright CXR. (20). CXR is systematically reviewed for evidence of hemothorax, and other traumatic injuries in suspected cases of trauma.11,12 Any abnormality on CXR should be followed by a computed tomography (CT) scan of the chest. Sensitivity, specificity and accuracy of portable chest radiograph for hemothorax is 96.2%,100% and 99.6% respectively.8
Dr. Uzma Mumtaz, , Zainab Zahur, Muhammad Ali Raza, Madiha Mumtaz. (2017) ULTRASOUND AND SUPINE CHEST RADIOGRAPH IN ROAD TRAFFIC ACCIDENTPATIENTS: A RELIABLE AND CONVENIENT WAY TO DIAGNOSE PLEURAL EFFUSION, JOURNAL OF AYUB MEDICAL COLLEGE ABBOTTABAD, Volume 29, Issue 4.
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