Accuracy of conventional imaging of penetrating torso injuries in the trauma resuscitation room.
Eur J Emerg Med
; 16(6): 305-11, 2009 Dec.
Article
em En
| MEDLINE
| ID: mdl-19417677
ABSTRACT
OBJECTIVES:
Chest X-ray (CXR), abdominal ultrasound, cardiac ultrasound, and abdominal X-ray are the most frequently used imaging modalities to radiologically evaluate patients with penetrating torso trauma. The aim of this study was to evaluate the accuracy of these imaging modalities.METHODS:
From January 2001 until January 2005, all consecutive patients with penetrating torso injuries presenting at the emergency department of a level 1 trauma center were included. Imaging modalities (chest/abdominal X-ray, abdominal/cardiac ultrasound), were compared retrospectively with a 'gold standard' (i.e. computed tomography or surgery within 2 h after arrival) or outcome of conservative treatment. The accuracy of the imaging modalities was calculated.RESULTS:
Three hundred and eighteen patients were included. On the basis of 299 CXRs, the sensitivity for diagnosing pneumothorax, hemothorax, and subcutaneous emphysema was 71, 63, and 61%, respectively. The sensitivity of abdominal ultrasound (N = 229) to detect free abdominal fluid and/or intra-abdominal injury was 65%. The specificity, positive predictive value, negative predictive value, and accuracy of the two imaging modalities to detect any of the diagnoses mentioned were >or=87%. Cardiac ultrasound (N = 31) did not show any false positive or negative results for detecting cardiac effusion. Pneumoperitoneum was not seen on abdominal X-ray in eight of 11 patients with perforation of a hollow organ.CONCLUSION:
Despite high specificity, positive predictive value, and negative predictive value, a considerable number of lesions remain undetected after CXR and abdominal ultrasound because of moderate-to-inadequate sensitivity. Abdominal X-ray hardly provides additional information. Careful clinical monitoring of patients is mandatory, particularly when computed tomography scan or operative treatment is not indicated.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ferimentos Penetrantes
/
Serviço Hospitalar de Emergência
/
Traumatismos Abdominais
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
/
Humans
/
Male
Idioma:
En
Revista:
Eur J Emerg Med
Assunto da revista:
MEDICINA DE EMERGENCIA
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Holanda