Work

Anatomical mapping of traumatic pneumothoraces missed by prehospital ultrasonography - a retrospective cohort study

Year: 2025

Type: article

Abstract: Objective Prehospital performed Extended Focused Assessment with Sonography in Trauma (EFAST) has poor sensitivity for pneumothorax (PTX) when compared to scans performed in hospital. This study describes the computed tomography (CT) location of PTX detected after an initial negative prehospital EFAST. Methods Trauma patients treated by New South Wales Ambulance (Aeromedical Operations) who underwent prehospital EFAST between 1 st August 2022 and 31 st December 2023 were included if they were found to have PTX on CT imaging following a negative or indeterminate prehospital EFAST ultrasound. Patients were excluded if prehospital pleural decompression was undertaken. Corresponding CT imaging was manually analysed for the location of each PTX and mapped to two-dimensional coordinates on an unfurled thoracic cage. Results Of 58 patients median (IQR) age was 29 (20, 58) years. The majority (76 %) were male who had sustained blunt trauma. The median (IQR) estimated PTX volume was 8 % (4-10) with 43 % of patients having a pneumothorax located to either the second intercostal space or most anterior portion of the chest on CT-mapping. The midpoints of each locule were anatomically distributed with a median (IQR) of 4 th (3 rd -5 th ) intercostal space and distance from the sternal edge (cm) of 4.1 (2.5-5.1) on the right, and 4.4 (3.5-5.2) on the left. Most PTX were sonographically occult due to apical, retrosternal, or posterior position. Conclusion Most traumatic PTX missed by prehospital EFAST were truly sonographically occult, but a significant number corresponded with the traditional scanning landmarks, particularly the parasternal 4 th intercostal space. This reinforces current literature advocating this scanning region. The balance between optimal detection and sono-paralysis should be considered for ongoing education and governance.

Source: Injury

DOI: 10.1016/j.injury.2025.112778

Authors: Isabella Marie, Jimmy Bliss, Christopher Partyka

Institutions: The University of Sydney, NSW Ambulance, Liverpool Hospital, Royal North Shore Hospital

Language: English

Topic: Ultrasound in Clinical Applications

Subfield: Critical Care and Intensive Care Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,640