US for the Detection of Pneumothorax in Injured Children: Preliminary Experience at a Community-Based Level II Pediatric Trauma Center
Donald Vasquez, DO, MPH; Gina Berg, PhD, MBA; Serge Srour, DO; Kamran Ali, MD
Wesley Medical Center, Wichita, KS
Chest trauma is a common cause of pneumothorax in the pediatric population and is evaluated using CT, chest x-ray, and ultrasound. CT is the gold-standard however, delivers the highest radiation dose. Ultrasound has been gaining popularity in the adult trauma population with reported sensitivities ranging from 58.9%-98.2%; however there is little data in the pediatric population.
METHOD AND MATERIALS
This was an Institutional Review Board approved retrospective medical record review of pediatric trauma patients that received extended focused assessment with sonography (EFAST) as part of the initial two point chest examination in the trauma bay between May 1, 2016 and September 21, 2017. EFAST findings were compared against chest x-rays, CT scans and, in the absence of those, clinical outcome.
403 of the 750 pediatric trauma patients identified underwent EFAST exam. Fifty-six percent (226) were confirmed with either a chest x-ray or a CT scan. Eleven pneumothoraces (2.7%) were observed. Of those, six were evaluated as false negatives on the EFAST. Analyses resulted in 45.5% sensitivity, 99.2 % sensitivity and 97.7% overall accuracy. Pneumothoraces undetected by EFAST were typically small and apical and likely not observed due to size and location (not under ultrasound probe).
Chest ultrasound demonstrated a low sensitivity in the pediatric population in our institution. Further research is needed to refine the role of chest ultrasound in injured children. Additionally there is a need for a standardized protocol which optimizes the sensitivity while maintaining a time sensitive exam in the trauma setting.
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