Engdahl O et al, 1993, Sweden | 16 consecutive adults with spontaneous pneumothorax | Prospective case controlled cohort | correlation between plain chest radiography and CT scans in determining size of pneumothorax | r = 0.71 (0.001<p<0.01) | Small cohort. Only included spontaneous pneumothoraces—no other aetiology. |
Collins CD et al, 1995, UK | 19 adults. 20 pneumothoraces. Spontaneous (7), iatrogenic (13) | Prospective controlled cohort study | formula to accurately calculate percentage pneumothorax from a plain chest radiograph | r = 0.98 (p < 0.0001) | No trauma patients included. Small cohort. Formula not validated in a prospective clinical trail. |
Blaivas M et al, 2005, USA | 176 adults who presented with blunt trauma. They all had a focussed assessment with sonography (FAST) ultrasound scan and were sufficiently ill to justify a CT scan of their chest. 53 had pneumothoraces either on CT scan; or post thoracostomy (if the clinician reported hearing a rush of air after placing a chest tube). | Prospective single blinded study with convenience sampling | to compare the sensitivity and specificity of supine chest x rays in the detection of pneumothorax using CT as the gold standard | Chest radiography sensitivity 75.5% (95% CI 61.7% to 86.2%) specificity 100% (95% CI 97.1% to 100%). Ultasound sensitivity 98.1% (95% CI 89.9% to 99.9%) specificity 99.2% (95% CI 95.6% to 99.9%) | only severely injured trauma patients, pneumothorax could have increased in size between investigations |
Kelly AM et al, 2006, Australia | 57 adult patients with spontaneous pneumothorax | Retrospective cohort review | Comparing two common methods to estimate the size of pneumothoraces on plain chest radiographs | They agree on smaller pneumothoraces but the Rhea method may significantly under-estimate the size of larger pneumothoraces | Small retrospective study. Did not compare either method to the accepted standard of a CT scan |