Abstract
Introduction
The initial evaluation of patients with thoracic trauma remains a diagnostic challenge for surgery and emergency physicians. Chest sonography plays a key role in the approach for this group of patients, through extended and focused evaluation with trauma sonography (E-FAST).
Objectives
To establish the diagnostic performance of the extension of the thoracic spine sign using chest sonography in trauma to diagnose hemothorax and compare it with the gold standard test chest computed tomography (CT).
Methods
This prospective observational study was conducted over 1 year. Patients who attended the emergency room with closed or penetrating thoracic or thoraco-abdominal trauma, an indication for a chest CT as part of a diagnostic evaluation according to institutional protocols, and who previously underwent a chest sonogram to determine the extent of the thoracic spine sign to diagnose hemothorax. Sonographic results were compared to a radiologist’s interpretation of the chest CT. The radiologists were blinded to the initial sonogram interpretation.
Results
Seventy-six patients were enrolled with an average age of 32 years. They mainly had closed trauma, which accounted for 77.6% of samples, and 222 chest images were taken. The sensitivity and specificity for this study were 78.7% and 92.6%, respectively, with a positive predictive value and negative predictive value of 65% and 97.8%, respectively.
Conclusions
Extension of the thoracic spine sign allows rapid identification of the presence, and more precisely, the absence of pleural effusion. This, therefore, allows an appropriate diagnosis and approach in the emergency room in patients with chest trauma.
Similar content being viewed by others
Code availability
Stata 15.
References
Heetveld MJ, Harris I, Schlaphoff G, Sugrue M. Guidelines for the management of haemodynamically unstable pelvic fracture patients. ANZ J Surg. 2004;74(7):520–9. https://doi.org/10.1111/j.1445-2197.2004.03074.x.
Montoya J, Stawicki SP, Evans DC, Bahner DP, Sparks S, Sharpe RP, et al. From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment. Eur J Trauma Emerg Surg. 2016;42(2):119–26. https://doi.org/10.1007/s00068-015-0512-1.
Ali J, Rozycki GS, Campbell JP, Boulanger BR, Waddell JP, Gana TJ. Trauma ultrasound workshop improves physician detection of peritoneal and pericardial fluid. J Surg Res. 1996;63(1):275–9. https://doi.org/10.1006/jsre.1996.0260.
Boyes JH. Editor’s Comment. J Hand Surg Am. 1981;6(4):413. https://doi.org/10.1016/S0363-5023(81)80062-7.
Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF, Kato K, et al. Focused assessment with sonography for trauma (FAST): results from an International Consensus Conference. J Trauma Int Infect Crit Care. 1999;46(3):466–72. https://doi.org/10.1097/00005373-199903000-00022.
Rowan KR, Kirkpatrick AW, Liu D, Forkheim KE, Mayo JR, Nicolaou S. Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT–initial experience. Radiology. 2002;225(1):210–4.
Kirkpatrick AW, Sirois M, Laupland KB, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004;57(2):288–95.
Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis. CJEM. 2019;21(6):727–38. https://doi.org/10.1017/cem.2019.381.
Montoya J, Stawicki SP, Evans DC, et al. From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment. Eur J Trauma Emerg Surg. 2016;42(2):119–26. https://doi.org/10.1007/s00068-015-0512-1.
Akoglu H, Celik OF, Celik A, Ergelen R, Onur O, Denizbasi A. Diagnostic accuracy of the extended focused abdominal sonography for trauma (E-FAST) performed by emergency physicians compared to CT. Am J Emerg Med. 2018;36(6):1014–7. https://doi.org/10.1016/j.ajem.2017.11.019.
Bloom BA, Gibbons RC. Focused assessment with sonography for trauma (FAST). In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 5, 2020. PMID: 29261902. Bookshelf ID: NBK470479.
Pumarejo Gomez L, Tran VH. Hemothorax. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020 Jun 29. PMID: 30855807. Bookshelf ID: NBK538219.
Richards JR, McGahan JP. Focused assessment with sonography in trauma (FAST) in 2017: what radiologists can learn. Radiology [Internet]. 2017;283(1):30–48. https://doi.org/10.1148/radiol.2017160107.
McGahan J, Richards J. The focused abdominal sonography for trauma scan. J Ultrasound Med [Internet]. 2002. https://doi.org/10.7863/jum.2002.21.7.789.
Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227–35. https://doi.org/10.1016/j.annemergmed.2006.01.008.
Dickman E, Terentiev V, Likourezos A, Derman A, Haines L. Extension of the thoracic spine sign: a new sonographic marker of pleural effusion. J Ultrasound Med. 2015;34(9):1555–611. https://doi.org/10.7863/ultra.15.14.06013.
Beam CA. Strategies for improving power in diagnostic Radiology research. AJR. 1992;159:631–7. https://doi.org/10.2214/ajr.159.3.1503041.
Atkinson P, Milne J, Loubani O, Verheul G. The V-line: a sonographic aid for the confirmation of pleural fluid. Crit Ultrasound J [Internet]. 2012;4(1):19. https://doi.org/10.1186/2036-7902-4-19.
Brooks A, Davies B, Smethhurst M, Connolly J. Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J. 2004;21(1):44–6. https://doi.org/10.1136/emj.2003.005438.
Raheja R, Brahmavar M, Joshi D, Raman D. Application of lung ultrasound in critical care setting: a review. Cureus. 2019;11(7):1–15. https://doi.org/10.7759/cureus.5233.
Lau JSK, Yuen CK, Mok KL, Yan WW, Kan PG. Visualization of the inferoposterior thoracic wall (VIP) and boomerang signs-novel sonographic signs of right pleural effusion. Am J Emerg Med [Internet]. 2018;36(7):1134–8. https://doi.org/10.1016/j.ajem.2017.11.023.
Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Shahsavari Nia K, Moghadas Jafari A, et al. Screening performance characteristic of ultrasonography and radiography in detection of pleural effusion; a meta-analysis. Emerg (Tehran, Iran) [Internet]. 2016;4(1):1–10.
Ma J, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;1(2):312–6. https://doi.org/10.1016/S0196-0644(97)70341-X.
Eibenberger KL, Dock WI, Ammann ME, Dorffner R, Hörmann MF, Grabenwöger F. Quantification of pleural effusions: sonography versus radiography. Radiology [Internet]. 1994;191(3):681–4. https://doi.org/10.1148/radiology.191.3.8184046.
Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227–35. https://doi.org/10.1016/j.annemergmed.2006.01.008.
Funding
Not applicable.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Fredy Watts, Carlos A. Vargas, Jaime A. Quintero, Roger Figueroa and Andres Castro declare that we have no conflict of interest.
Ethical approval
This study was approved by the biomedical investigation ethics committee at the institution at which the study was performed.
Consent to participate
This study was approved by the biomedical investigation ethics committee at the institution at which the study was performed. According to resolution 8430 of 1993 of the Colombian Ministry of Health, the descriptive studies are of lower risk than the minimum, taking into account that no interventions or modification of biological or physiological variables will be carried out. Therefore, the ethics committee was not asked to exempt informed consent.
Rights and permissions
About this article
Cite this article
Vargas, C.A., Quintero, J., Figueroa, R. et al. Extension of the thoracic spine sign as a diagnostic marker for thoracic trauma. Eur J Trauma Emerg Surg 47, 749–755 (2021). https://doi.org/10.1007/s00068-020-01459-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-020-01459-1