One or four-view POCUS for PTX

Short Attention Span Summary

One or four views for PTX on POCUS?
In this RCT, single-view point of care ultrasound (POCUS) performed with nearly identical sensitivity and specificity to 4-view POCUS for clinically significant pneumothorax (PTX) on CT - "single-view US demonstrated a sensitivity of 93% (95% CI = 64.1% to 99.6%) and a specificity of 99.2% (95% CI = 95.5% to 99.9%), with sensitivity of 93.3% (95% CI = 66% to 99.7%) and specificity of 98% (95% CI = 92.1% to 99.7%) for four views."
For any PTX, not just clinically significant, single and 4-view had, respectively, "sensitivity (54.2 and 68%) but high specificity (99 and 98%)."

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Single view POCUS was as good as 4-view in detecting clinically significant PTX.


Abstract

Acad Emerg Med. 2016 Oct;23(10):1170-1175. doi: 10.1111/acem.13054. Epub 2016 Sep 27.

Comparison of Four Views to Single-view Ultrasound Protocols to Identify Clinically Significant Pneumothorax.

Helland G1,2, Gaspari R3, Licciardo S3, Sanseverino A3, Torres U4, Emhoff T4, Blehar D3.

Author information:

1Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA. ghelland@medicine.bsd.uchicago.edu.

2Department of Medicine, University of Chicago, Chicago, IL. ghelland@medicine.bsd.uchicago.edu.

3Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.

4Department of Surgery, University of Massachusetts Medical School, Worcester, MA.

Abstract

OBJECTIVE:

Ultrasound (US) has been shown to be effective at identifying a pneumothorax (PTX); however, the additional value of adding multiple views has not been studied. Single- and four-view protocols have both been described in the literature. The objective of this study was to compare the diagnostic accuracy of single-view versus four-view lung US to detect clinically significant PTX in trauma patients.

METHODS:

This was a randomized, prospective trial on trauma patients. Adult patients with acute traumatic injury undergoing computed tomography (CT) scan of the chest were eligible for enrollment. Patients were randomized to a single view or four views of each hemithorax prior to any imaging. USs were performed and interpreted by credentialed physicians using a 7.5-Mhz linear array transducer on a portable US machine with digital clips recorded for later review. Attending radiologist interpretation of the chest CT was reviewed for presence or absence of PTX with descriptions of small foci of air or minimal PTX categorized as clinically insignificant.

RESULTS:

A total of 260 patients were enrolled over a 2-year period. A total of 139 patients received a single view of each chest wall and 121 patients received four views. There were a total of 49 patients that had a PTX (19%), and 29 of these were clinically significant (11%). In diagnosis of any PTX, both single-view and four-view techniques showed poor sensitivity (54.2 and 68%) but high specificity (99 and 98%). For clinically significant PTX, single-view US demonstrated a sensitivity of 93% (95% confidence interval [CI] = 64.1% to 99.6%) and a specificity of 99.2% (95% CI = 95.5% to 99.9%), with sensitivity of 93.3% (95% CI = 66% to 99.7%) and specificity of 98% (95% CI = 92.1% to 99.7%) for four views.

CONCLUSIONS:

Single-view and four-view chest wall USs demonstrate comparable sensitivity and specificity for PTX. The additional time to obtain four views should be weighed against the absence of additional diagnostic yield over a single view when using US to identify a clinically significant PTX.

© 2016 by the Society for Academic Emergency Medicine.

PMID: 27428394 [PubMed - in process]