article · International Journal of Emergency Medicine
Rapid detection of thoracic trauma injuries, such as pneumothorax, hemothorax, and lung contusion, is essential for timely clinical care. A clinical study involving 76 adult trauma patients evaluated the diagnostic accuracy of transthoracic ultrasound against standard chest radiography, using computed tomography as the benchmark reference. Ultrasound demonstrated superior performance across all evaluated injury types. For pneumothorax, ultrasound achieved 91 percent sensitivity and 95 percent accuracy, whereas radiography reached 69 percent sensitivity and 82 percent accuracy. For hemothorax, ultrasound demonstrated 96 percent sensitivity and 97 percent accuracy, compared to 62 percent sensitivity and 74 percent accuracy for radiography. In detecting lung contusion, ultrasound delivered 86 percent sensitivity and 89 percent accuracy, vastly outperforming radiography which showed 25 percent sensitivity and 43 percent accuracy. Transthoracic ultrasound showed strong agreement with computed tomography scans, confirming its reliability over radiography in emergency diagnostic settings.
Chest trauma is a leading cause of severe complications and death in injured patients. Chest computed tomography provides an accurate diagnosis but may not always be immediately accessible. Demonstrating that bedside transthoracic ultrasound significantly outperforms standard chest radiography enables emergency medical teams to identify life-threatening lung and pleural injuries more swiftly and reliably, facilitating prompt intervention.
These findings support the clinical adoption of point-of-care ultrasound devices and targeted diagnostic protocols by emergency medical personnel and trauma units. The technique represents an applied clinical method directly tested in an emergency department setting. However, because the evidence comes from a single-centre trial with a relatively small cohort, broader commercial clinical protocol integration or regulatory deployment guidelines would require validation through larger multicentre trials.
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BACKGROUND: Thoracic trauma is a major cause of morbidity and mortality in trauma patients. Rapid detection of pneumothorax, hemothorax, and lung contusion is critical for timely management. This study aimed to evaluate the diagnostic accuracy of transthoracic ultrasound compared with chest radiography in thoracic trauma patients using chest computed tomography (CT) as the reference standard. METHODS: This prospective diagnostic accuracy study was conducted in the Emergency Department of Menoufia University Hospital between July 2023 and December 2024. Adult trauma patients with suspected thoracic injury were consecutively enrolled. All patients underwent transthoracic ultrasound, chest radiography, and chest CT. Diagnostic performance of ultrasound and chest radiography for detecting pneumothorax, hemothorax, and lung contusion was assessed using CT as the reference standard. Sensitivity, specificity, predictive values, accuracy, and Cohen's kappa agreement were calculated. RESULTS: A total of 76 trauma patients were included in the final analysis (mean age 42.5 ± 12.7 years; 77.6% male), with blunt trauma accounting for 78.9% of injuries. CT identified pneumothorax in 45 patients (59.2%), hemothorax in 53 (69.7%), and lung contusion in 57 (75.0%). Transthoracic ultrasound detected pneumothorax in 41 patients (53.9%), hemothorax in 51 (67.1%), and lung contusion in 49 (64.5%), whereas chest radiography detected these injuries in 31 (40.8%), 33 (43.4%), and 14 patients (18.4%), respectively. Ultrasound demonstrated higher diagnostic performance than chest radiography across all injury types. For pneumothorax detection, ultrasound showed 91% sensitivity and 95% diagnostic accuracy compared with 69% sensitivity and 82% accuracy for chest radiography. For hemothorax detection, ultrasound achieved 96% sensitivity and 97% accuracy versus 62% sensitivity and 74% accuracy for chest radiography. For lung contusion detection, ultrasound demonstrated 86% sensitivity and 89% accuracy, whereas chest radiography showed only 25% sensitivity and 43% accuracy. Agreement with CT was strong for ultrasound (κ = 0.75-0.94) but lower for chest radiography (κ = 0.14-0.64). CONCLUSION: Transthoracic ultrasound demonstrated high diagnostic performance and good agreement with chest CT for detecting traumatic thoracic injuries and outperformed chest radiography in this study. However, given the single-center design and relatively limited sample size, larger multicenter studies are warranted to validate these findings.
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DOI: 10.1186/s12245-026-01319-6
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