Table 3
Author, date, countryPatient groupStudy typeOutcomesKey resultsStudy weaknesses
CT, computed tomography; NPV, negative predictive value; PPV, positive predictive value.
Rothlin et al, 1993, SwitzerlandAdults (aged 15–88 years) with blunt thoracic or abdominal injuries. Ultrasound scan by surgeons compared to the patients’ clinical outcome and other diagnostic techniquesProspective studyClinical utility of ultrasound to detect haemothoraxSensitivity 81%Poor gold standard. Not performed by emergency physicians. Some of the beginner surgeons initially forgot to check for haemothorax, accounting for 5 of the 11 cases of false negative reports by ultrasound. Some of the effusions developed only after the first 24 h and therefore would not have been visible on the initial ultrasound scan
Ma et al, 1995, USA245 adult (18 years +) patients presenting to the emergency department with major blunt or penetrating torso trauma. Diagnosis with ultrasound was compared to a combination of results of other diagnostic techniques including CT scan, supine chest x ray, formal two-dimensional echocardiography or tube thoracostomyDiagnostic cohortClinical utility of rapid ultrasound assessment at detecting the presence of haemothoraxSensitivity 96%, specificity 100%, accuracy 99%Composite gold standard
Ma and Mateer, 1997, USA240 adults (aged 18 years+) presenting to the emergency department with a major blunt or penetrating torso trauma. Accuracy of ultrasound compared with that of initial plain supine chest x ray for the detection of haemothorax using a combination of CT and tube thoracostomy as the gold standardRetrospective analysis of a prior prospective studyClinical utility of ultrasound vs initial plain supine chest x ray for the detection of haemothoraxSensitivity 96.2% vs 96.2%, specificity 100% vs 100%, accuracy 99.6% vs 99.6%The same patients as reference 2
Sisley et al, 1998, USAPatients with suspected blunt or penetrating torso injury who required a chest radiograph for a complete evaluationProspective studyClinical utility of ultrasound vs supine chest x ray at detecting the presence of haemothoraxSensitivity 97.5% vs 92.5%, specificity 99.7% vs 99.7%, PPV 97.5% vs 97.4%, NPV 99.7% vs 99.1%The results of ultrasound were compared to those of supine chest x ray rather than them both being compared to an independent “gold standard”. Emergency physicians did not perform the ultrasound scan
Abboud and Kendall, 2003, USABlunt trauma patients who underwent CT scan of their chest as part of their clinical assessmentProspective studyClinical utility of ultrasoundSensitivity 12.5%, specificity 98.4%None of the haemothoraces detected by CT but not on ultrasound were large enough to be clinically relevant. The interval between the ultrasound scan and the CT scan was up to 4 h
Brooks et al, 2004, UKPatients triaged to the resuscitation room with thoracic trauma (blunt or penetrating). Ultrasound findings were compared against a combination of other diagnostic methods including supine chest x ray, intercostal drain, CT or tube thoracotomyProspective studyClinical utility of ultrasound at detecting the presence of haemothoraxSensitivity 92%, specificity 100%, accuracy 98%, PPV 100%, NPV 98%Composite gold standard