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Three Part Question

For [patients with acute shortness of breath], is using [thoracic ultrasound] more sensitive than [chest radiography] in [detecting traumatic pneumothorax]?

Clinical Scenario

A 45-year-old man presents to the emergency department after a motor vehicle accident. His only complaints are shortness of breath and abdominal pain. A focused assessment with sonography in trauma (FAST exam) is used to evaluate the patient's abdomen and chest. You wonder what is the accuracy of extending the FAST to detect pneumothorax.

Search Strategy

Medline 1966-05/24 using PubMed, Cochrane Library (2024), and Embase
[(pneumothorax AND ultrasonography) AND (sensitivity OR specificity)] LIMIT to English language.

Search Outcome

294 total articles were found, one systematic review and one clinical study were identified as both relevant and of sufficient quality for inclusion.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Tian H, et al March 2023 China/India	12 prospective studies with trauma patients attending emergency department	Meta-analysis	Sensitivity of US	89% (95% CI, 86-91%)	Subgroup analysis showed that the sampling method, setting (trauma vs. non-trauma), operator type and probe were significant sources of heterogeneity
			Specificity of US	96% (95% CI, 95-97%)
			Diagnostic odds ratio	193.94 (95% CI, 59.0-637.4)
Aswin K, et al. August 2023 India	All consecutive patients (n=255) with a suspected history of chest trauma	Cross-sectional diagnostic study	Sensitivity of bedside US compared to CXR	85.7% versus 71.4%	Composite gold standard was used, not all patients had a computerized tomography (CT) scan.
			Specificity of bedside US compared to CXR	95.3% versus 100%

Comment(s)

The lack of lung sliding on an extended FAST (eFAST) is usually pathognomonic of a pneumothorax, especially in the context of trauma. Even though eFAST is more sensitive than a plain CXR for pneumothorax, it may not be as specific.

Clinical Bottom Line

Thoracic ultrasound (or eFAST) is a rapid and reliable tool to diagnose pneumothorax.

References

1. Tian H, Zhang T, Zhou Y, Rastogi S, Choudhury R, Iqbal J. Role of emergency chest ultrasound in traumatic pneumothorax. An updated meta-analysis. Med Ultrason 2023 Mar 30;25(1):66-71.
2. Aswin K, Balamurugan S, Govindarajalou R, Saya GK, Elamurugan TP, Rajendran G. Comparing Sensitivity and Specificity of Ultrasonography With Chest Radiography in Detecting Pneumothorax and Hemothorax in Chest Trauma Patients: A Cross-Sectional Diagnostic Study Cureus 2023 Aug 31;15(8):e44456.