Low Diagnostic Accuracy of Transthoracic Ultrasound for the Assessment of Spontaneous Pneumothorax in the Emergency Setting: A Multicentric Study

Author:

Quarato Carla Maria Irene1ORCID,Mirijello Antonio2ORCID,Bocchino Marialuisa3,Feragalli Beatrice4,Lacedonia Donato1,Rea Gaetano5ORCID,Lieto Roberta5ORCID,Maggi Michele6,Hoxhallari Anela1,Scioscia Giulia1ORCID,Vicario Aldo3,Pellegrino Giuseppe6,Pazienza Luca7,Villani Rosanna8ORCID,Bellanova Salvatore8,Bracciale Pierluigi9,Notarangelo Stefano10,Morlino Paride10,De Cosmo Salvatore2,Sperandeo Marco11

Affiliation:

1. Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71122 Foggia, Italy

2. Department of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy

3. Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy

4. Department of Radiology, “SS. Annunziata” Hospital, University of Chieti, 66100 Chieti, Italy

5. Department of Radiology, Monaldi Hospital—Azienda Ospedaliera di Rilievo Nazionale (AORN) dei Colli, 80131 Naples, Italy

6. Department of Emergency Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy

7. Unit of Radiology, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy

8. Department of Medical and Surgical Sciences, Institute of Internal Medicine, University of Foggia, 71122 Foggia, Italy

9. Pneumology and Respiratory Semi-intensive Care Unit, Ostuni Hospital, 72017 Ostuni, Italy

10. Respiratory Diseases and Respiratory Rehabilitation, “Teresa Masselli Mascia” Hospital, 71016 San Severo, Italy

11. Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy

Abstract

Background: Pneumothorax (PNX) represents a common clinical condition in emergency departments (EDs), requiring prompt recognition and treatment. The role of transthoracic ultrasounds (TUSs) in the diagnosis of PNX is still debated. We aimed to prospectively evaluate the accuracy of TUSs in the detection of spontaneous PNX in EDs. Methods: A total of 637 consecutive adult patients who presented to the EDs of four Italian hospitals complaining of acutely onset chest pain and dyspnoea were included in the study. Exclusion criteria were previous traumatic events, cardiogenic causes of pain/dyspnoea and suspected tension PNX. The absence of “lung sliding” (B-mode) and the “bar-code” sign (M-mode) were considered indicative of PNX in a TUS. Accuracy, sensitivity, specificity, and positive and negative predictive values (PPVs, NPVs) were calculated using a chest CT scan as reference. Results: Spontaneous PNX occurred in 93 patients: of those, 83 (89.2%) were correctly identified by TUSs. However, 306 patients with suspected PNX at TUS were not confirmed by chest CTs. The diagnostic accuracy of both the absence of “lung sliding” and “bar-code” sign during TUS was 50.4% (95% CI: 46.4–54.3), sensitivity was 89.2% (95% CI: 81.1–94.7), specificity was 43.8% (95% CI: 39.5–48.0), the PPV was 21.3% (95% CI: 19.7–23.1) and the NPV was 96.0% (95% CI: 92.9–97.7). Conclusions: TUS showed high sensitivity but low specificity in the identification of PNX in EDs. Relying exclusively on TUSs results for patients’ management in ED settings is neither suitable nor recommendable. TUS examination can be useful to strengthen the clinical suspicion of PNX, but its results should be confirmed by a chest X-ray or CT scan.

Publisher

MDPI AG

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