Feasibility of ultraportable US in detecting clinically concerning recurrent pneumothorax in patients with chest trauma.

Abstract

Background: Bedside thoracic ultrasound (US) offers numerous advantages over chest X-ray (CXR) for identification of recurrent pneumothoraces (PTX) after tube thoracostomy (TT) removal. Technologic advancements have led to the development of hand-held devices capable of producing high-quality images termed ultra-portable US (UPUS). We hypothesized that UPUS would be as successful as CXR in detecting post-TT removal PTX and would be preferred by patients.

Methods: We conducted a single-center prospective, feasibility, study at a level I trauma center investigating the use of UPUS in patients with trauma with TT placement. UPUS images were obtained daily while the TT was in place and post-TT removal (ranging from 1 through 6 hours). A clinically concerning PTX on UPUS was defined as the absence of lung sliding on two or more intercostal spaces. Poststudy Likert surveys were administered to assess patient preferences.

Results: Ninety-two patients were included in the analysis. The majority were men (87%), and the median age was 47 years. Thirty-five patients (36%) had discordant imaging findings. There were 11 clinically concerning PTX, of which 10 (91%) were detected on UPUS and 8 (73%) on CXR. Three patients required an intervention for post-pull PTX, all of whom were identified on UPUS. Eighty-four percent (N=70) of surveyed patients preferred UPUS over CXR with 92% reporting no discomfort with UPUS compared with 49% with CXR.

Conclusion: Bedside UPUS is preferred by patients and can successfully identify clinically concerning post-TT removal PTX. Implementation of UPUS as a post-TT removal diagnostic tool is a safe and effective alternative to CXR.

Level of evidence: Level II, diagnostic tests or criteria.