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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2007

01-12-2007 | Brief Report

Multiplanar reconstruction: a new method for the diagnosis of tracheobronchial rupture?

Authors: Alexandre Faure, Bernard Floccard, Frank Pilleul, Frédéric Faure, Bruno Badinand, Nicolas Mennesson, Thierry Ould, Christian Guillaume, Albrice Levrat, Farida Benatir, Bernard Allaouchiche

Published in: Intensive Care Medicine | Issue 12/2007

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Abstract

Objective

To compare multiplanar reconstruction with operative techniques (bronchoscopy, surgery and/or autopsy) for the diagnosis of tracheobronchial rupture.

Design

Prospective, observational study.

Setting

Surgical intensive care unit.

Patients and participants

Tracheobronchial rupture was suspected on clinical grounds and from radiological findings.

Interventions

An initial helical computed tomography scan was performed on all patients meeting the inclusion criteria, and operative techniques were then performed. Multiplanar reconstructions were reformatted and reviewed by two independent radiologists.

Measurements and results

Twenty-four consecutive patients met the inclusion criteria. Tracheobronchial rupture was diagnosed in 13 patients by at least one operative technique. Multiplanar reconstructions were positive in 15 patients. The diagnostic sensitivity and specificity of multiplanar reconstructions were 100% (95%CI, 85–100) and 82% (95%CI, 64–82), respectively. The positive and negative predictive values were 87% (95%CI, 74–87) and 100% (95%CI, 78–100), respectively. For tracheobronchial rupture, the positive and negative likelihood ratios were 5.5 (95%CI, 2.35–5.5) and 0 (95%CI, 0–0.24), respectively. The Kappa coefficients were 0.83 (95%CI, 0.6–1.06) for agreement between operative techniques and multiplanar reconstruction, and 0.91 (95%CI, 0.59–0.91) for agreement between the two radiologists.

Conclusions

Multiplanar reconstruction appears to be a sensitive technique for the identification of tracheobronchial rupture because of its excellent negative likelihood ratio. In clinical practice, negative multiplanar reconstruction can exclude a diagnosis of tracheobronchial rupture, making bronchoscopy unnecessary. When multiplanar reconstruction is positive, tracheobronchial rupture should be confirmed by bronchoscopy.

Descriptor

Trauma.
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Metadata
Title
Multiplanar reconstruction: a new method for the diagnosis of tracheobronchial rupture?
Authors
Alexandre Faure
Bernard Floccard
Frank Pilleul
Frédéric Faure
Bruno Badinand
Nicolas Mennesson
Thierry Ould
Christian Guillaume
Albrice Levrat
Farida Benatir
Bernard Allaouchiche
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 12/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0830-9

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