Regardless of the type of trauma, type of chest ultrasonography (CUS) operator, or type of CUS probe used, the overall sensitivity of CUS is superior to supine chest x-ray (CXR) for diagnosing pneumothorax, and their specificities are similar, according to study results published in Cochrane Database of Systematic Reviews.

CUS may be a safer, more rapid, and more accurate modality for diagnosing pneumothorax in trauma patients at the bedside compared with CXR. Researchers sought to compare the diagnostic accuracy of CUS by frontline nonradiologist physicians vs CXR for the diagnosis of pneumothorax in trauma patients in the emergency department and investigate the effects of potential sources of heterogeneity such as type of CUS operator, type of trauma (blunt vs penetrating), and type of US probe on test accuracy.

Through a comprehensive literature search, 13 studies were identified of which 9 (410 patients with traumatic pneumothoraces out of 1271 total patients) used patients as the unit of analysis and included them in the primary analysis; the remaining 4 studies used lung field as the unit of analysis and were included in a secondary analysis.

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The researchers found that CUS is more accurate than CXR in diagnosing pneumothorax in trauma patients, which may lead to more timely treatment with tube thoracostomy, reduced pneumothorax-related complications, and improved outcomes. Although there was a significant difference in the sensitivity of CUS vs CXR (absolute difference, 0.44; 95% CI, 0.27-0.61; P <.001), both had similar specificities (absolute difference of -0.007; 95% CI, -0.018 to 0.005; P =.35).

“The findings of this review provide evidence for the incorporation of CUS into trauma (eg, [Advanced Trauma Life Support]) protocols and algorithms in future medical training programs, and could beneficially change routine management of trauma,” the study authors wrote.


Chan KK, Joo DA, McRae AD, et al. Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department (Review). Cochrane Database Syst Rev. 2020;7(7):CD013031.