الاستكشاف السريع للاسترواح الصدري بواسطة جهاز السونار في المريض المتعدد الاصابات == Rapid detection of pneumothorax by Ultrasonography in patient with multiple traumas
Author name:
فاضل خليفة موسى
Supervisor name:
قصي عبد فهد
General topic:
Medicine
Specific topic:
Diagnostic Radiology
Degree:
Master
University:
University of Baghdad - Faculty Of Medicine
Language:
English
University location:
Baghdad
First pages:
19T1338 - p.pdf
Abstract:
الغرض من الدراسة هو لمعرفة قابلية طبيب الاشعة لاستكشاف الاسترواح الصدري في مرضى الاصابات المتعددة والطارئة في شعبة الطوارئ في جهاز السونار ومقارنة النتائج مع نتائج المفراس. تم البحث خلال فترة عشرة اشهر وتم اجراء فحص السونار الى 37 مصاب على شكل 30 (81%) منهم رجال و7(19%) نساء وباعمار تتراواح مابين 30 - 50 سنة. واظهرت النتائج انه يمكن فحص المرضى ذوات الاصابات المتعددة بجهاز سونار الطوارئ ومعرفة وجود الاسترواح الصدري حيث اظهرت النتائج ان دقة الكشف تتناسب مع كمية الهواء الموجود داخل غشاء الجنب. حيث كلمزاادت الكمية زادت قابلية الكشف وبتناسب طردي. الغرض من هذا البحث هو امكانية الاستغناء عن المفراس لبحلزوني واشعة الصدر في الكشف عن الاسترواح الصدري وخاص في الكميات المتوسطة والكبيرة من الهواء. | Early detection of pneumothorax in multiple trauma patients is critically important. It can be argued that the efficacy of ultrasonography (US) for detection of pneumothorax is enhanced if it is performed and interpreted directly by the clinician in charge of the patients.The aim of this study was to assess the ability of clinician to perform bedside US to detect and assess the size of the pneumothorax in patients with multiple trauma.MethodsOver a 10 month period, patients with multiple traumas treated in the emergency department were enrolled in this prospective study. Bedside US was performed in emergency department.Portable supine chest radiography (CXR) and computed tomography (CT) were obtained within an interval of three hours. Using CT and chest drain as the gold standard, the diagnostic efficacy of US and CXR for the detection of pneumothorax, defined as rapidity and accuracy (sensitivity, specificity, positive predictive value, negative predictive value), were compared. The size of the pneumothorax (small, medium and large) determined by US was also compared to that determined by CT.Results : The study included 37 patients 30 (81%) of them were males and 7 (19%) were females.The average age was 42 ± 11.6 years. All patients presented trauma, including explosives and missiles injuries (37.8%) RTA (24.3%), falls (16.2%), and others (21.6%).Out of the 37 trauma patients, 32 did had pneumothorax according to the gold standard (CT scanning) and five patients did not, according to the ultrasonography findings of those patients, 30 patients did had pneumothorax (true positive) and 2 patients missed by ultrasonography, while 5 patients did not have pneumothorax on CT, ultrasound correctly identify 4 of them as negative (true negative), so the sensitivity and specificity and accuracy of ultrasonography were 93.7%, 80% and 92% respectively.The size of pneumothorax which had been determined by ultrasonography (17) patient had identified as large pneumothorax, (9) patients as moderate and (4) patients as mild, while CT findings were (17,9 and 6) respectively, when a kappa agreement test had been performed, it had been significantly found that US agreement with the CT was directly associated with the size of pneumothorax, US has more agreement, more sensitivity and more specificity in large and moderate pneumothorax rather than mild pneumothorax in trauma patients, P< 0.05.Conclusion My US examination provides a reliable tool and has the advantages of being simple and rapid as compared with CT and CXR and having high sensitivity as compared to CXR for the detection of pneumothorax in patients with multiple trauma.
