Clinical Assistant Professor of Pediatrics Renaissance School of Medicine at Stony Brook University Stony Brook, New York, United States
Background: Trauma is one of the leading causes of morbidity and mortality in children and adults. Point of care ultrasound (PoCUS) can rapidly identify life threatening injuries requiring urgent intervention. Ultrasound has increased sensitivity in detection of occult PTX those that are present but are not identified on routine chest x-ray, gold standard being CT. Despite widespread application of PoCUS in adult trauma, its application and accuracy has not been adequately studied in pediatrics. Objective: The objective of this study is to evaluate the accuracy of PoCUS in diagnosing PTX in a cohort of pediatric trauma patients requiring the highest level trauma activation. Additionally we sought to evaluate the accuracy of PoCUS in diagnosis of PTX requiring decompression with thoracostomy. Design/Methods: This is a retrospective observational cohort study from a suburban Level 1 adult and pediatric trauma center. Records were identified from the Suffolk County trauma registry. Patients < 17 years were included if they presented to the ED between June 1, 2019 and October 31, 2022 and the highest-level pediatric trauma activation was called. Records were excluded for patients receiving chest imaging prior to transfer, those who underwent needle or tube thoracostomy prior to arrival, and those in traumatic arrest. Statistical analysis was performed with 95% confidence intervals reported. Results: In our cohort of 89 patients, mean age was 10 years (SD=5), 67% were male, 10% sustained penetrating trauma, and the overall prevalence of PTX was 4%. A subset of 46 patients (52%) had PoCUS performed primarily. PoCUS identified 1 patient with PTX requiring tube thoracostomy. PoCUS was negative for PTX in the remainder, none of whom had other imaging positive for PTX or required thoracostomy. Sensitivity of PoCUS for PTX as well as for PTX requiring intervention was 100% (95% CI 0.057-1.0), Specificity 100% (0.979-1.0), Positive predictive value (PPV) 100% (0.057-1.0), Negative predictive value 100% (0.979-1.0).
Conclusion(s): In a population of patients < 17 years of age meeting the highest level of pediatric trauma activation and mostly suffering blunt trauma, the test characteristics of PoCUS in the diagnosis and exclusion of PTX were exceptional. The NPV of PoCUS performed prior to other imaging may be sufficient to exclude PTX or clinically significant PTX without additional imaging. Due to the retrospective nature of this study and the relatively small sample of PTX in this cohort, larger prospective studies are needed to further test the sensitivity and PPV of PoCUS.
