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Bedside Ultrasound in the Diagnosis of Postprocedure Pneumothorax
October 2012, Vol 142, No. 4_MeetingAbstracts Respiratory Care | October 2012
Bedside Ultrasound in the Diagnosis of Postprocedure Pneumothorax Eugene Shostak*, MD; Douglas Brylka, MD; Joseph Krepp, MD; Bradley Pua, MD; Abraham Sanders, MD New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY Chest. 2012;142(4_MeetingAbstracts):935A. doi:10.1378/chest.1382456
Abstract SESSION TYPE: Hot Topics in Respiratory & Critical Care PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM PURPOSE: The purpose of this study was to evaluate the effectiveness of bedside ultrasound in the diagnosis of procedure related pneumothorax. METHODS: A series of 185 patients underwent thoracentesis (n=60), transbronchial biopsy (n=48), CT-guided lung biopsy (n=74), CT-guided mediastinal mass biopsy (n=2), and CT-guided cryoablation of a lung mass (n=1). A bedside transthoracic ultrasound examination and a post-procedure chest radiograph were performed in all patients, an average 36 min and 48 min after the procedure, respectively. An immediate post-procedure CT was performed in patients undergoing CT-guided lung and mediastinal mass biopsies. The gold standard was a positive chest CT for pneumothorax. The ultrasound was compared with a post-procedure chest radiograph if the CT was not performed or was negative for a pneumothorax. Ultrasound was performed and interpreted by the clinical investigator and concomitantly interpreted by a radiologist. RESULTS: Pneumothorax was detected in 13/185 patients (7.0%). Five pneumothoraces were missed by an ultrasound, three of which were also not seen on a chest radiograph. None of the missed pneumothoraces were clinically significant at the time of ultrasound exam. The sensitivity, specificity, positive predictive value, negative predictive value, and the diagnostic accuracy for an ultrasound were 62, 99, 73, 97, and 96%, respectively. The 95% confidence intervals of the differences in sensitivity, specificity, positive predictive value, negative predictive value and the diagnostic accuracy were 0.35-0.90, 0.93-0.98, 0.29-0.80, 0.94-0.98, and 0.93-0.98, respectively. The inter-observer agreement between the clinical investigator and the radiologist in the interpretation of ultrasound was 97% (k=0.8, p value≤0.001). CONCLUSIONS: Bedside chest ultrasonography can reliably exclude clinically significant post procedure pneumothorax. CLINICAL IMPLICATIONS: Bedside ultrasound is a valuable point-of-care tool that can be used by clinicians in the diagnosis of clinically significant post-
interventional pneumothorax and may obviate the need for routine post procedure chest radiograph. DISCLOSURE: The following authors have nothing to disclose: Eugene Shostak, Douglas Brylka, Joseph Krepp, Bradley Pua, Abraham Sanders No Product/Research Disclosure Information New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
Bedside Ultrasound in the Diagnosis of Postprocedure Pneumothorax Eugene Shostak*, MD; Douglas Brylka, MD; Joseph Krepp, MD; Bradley Pua, MD; Abraham Sanders, MD New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY Chest. 2012;142(4_MeetingAbstracts):935A. doi:10.1378/chest.1382456
Abstract SESSION TYPE: Hot Topics in Respiratory & Critical Care PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM PURPOSE: The purpose of this study was to evaluate the effectiveness of bedside ultrasound in the diagnosis of procedure related pneumothorax. METHODS: A series of 185 patients underwent thoracentesis (n=60), transbronchial biopsy (n=48), CT-guided lung biopsy (n=74), CT-guided mediastinal mass biopsy (n=2), and CT-guided cryoablation of a lung mass (n=1). A bedside transthoracic ultrasound examination and a post-procedure chest radiograph were performed in all patients, an average 36 min and 48 min after the procedure, respectively. An immediate post-procedure CT was performed in patients undergoing CT-guided lung and mediastinal mass biopsies. The gold standard was a positive chest CT for pneumothorax. The ultrasound was compared with a post-procedure chest radiograph if the CT was not performed or was negative for a pneumothorax. Ultrasound was performed and interpreted by the clinical investigator and concomitantly interpreted by a radiologist. RESULTS: Pneumothorax was detected in 13/185 patients (7.0%). Five pneumothoraces were missed by an ultrasound, three of which were also not seen on a chest radiograph. None of the missed pneumothoraces were clinically significant at the time of ultrasound exam. The sensitivity, specificity, positive predictive value, negative predictive value, and the diagnostic accuracy for an ultrasound were 62, 99, 73, 97, and 96%, respectively. The 95% confidence intervals of the differences in sensitivity, specificity, positive predictive value, negative predictive value and the diagnostic accuracy were 0.35-0.90, 0.93-0.98, 0.29-0.80, 0.94-0.98, and 0.93-0.98, respectively. The inter-observer agreement between the clinical investigator and the radiologist in the interpretation of ultrasound was 97% (k=0.8, p value≤0.001). CONCLUSIONS: Bedside chest ultrasonography can reliably exclude clinically significant post procedure pneumothorax. CLINICAL IMPLICATIONS: Bedside ultrasound is a valuable point-of-care tool that can be used by clinicians in the diagnosis of clinically significant post-
interventional pneumothorax and may obviate the need for routine post procedure chest radiograph. DISCLOSURE: The following authors have nothing to disclose: Eugene Shostak, Douglas Brylka, Joseph Krepp, Bradley Pua, Abraham Sanders No Product/Research Disclosure Information New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY