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The accuracy of physical examination in identifying significant pathologies in penetrating thoracic trauma

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Abstract

Introduction

Accurate physical examination (PE) remains a key component in the assessment of penetrating thoracic trauma (PTT), despite the increasing availability of advanced radiological imaging. Evidence regarding the accuracy of PE in identifying significant pathology following PTT is limited.

Materials and methods

A retrospective review of 405 patients was undertaken over a twelve-month period to determine the accuracy of PE in identifying significant pathology (SP) subsequently confirmed on chest radiographs (CXRs) in patients who sustained stab injuries to the thorax.

Results

Ninety-seven per cent (372/405) of patients were males, and the mean age was 24 years. The weapons involved were knives in 98 % (398/405), screwdrivers in 1 % (3/405) and unknown in the remaining 1 %. Fifty-nine per cent (238/405) of all injuries were on the left side. There were 306 (76 %) SPs identified on CXR. Ninety-nine (24 %) CXRs were entirely normal. Based on PE alone, 223 (55 %) patients were thought to have SPs present, 182 (45 %) patients were thought to have no SPs. The overall sensitivity of PE in identifying SPs was 68 % (63–73, 95 % CI), with a specificity of 86 % (77–92, 95 % CI). The PPV of PE was 94 % (90–97, 95 % CI) and the NPV was 47 % (39–54, 95 % CI). The sensitivity of PE for identifying a pneumothorax was 59 % (51–66, 95 % CI), with a specificity of 96 % (89–99, 95 % CI) and the sensitivity of PE for identifying a haemothorax was 79 % (72–86, 95 % CI), with a specificity of 96 % (89–99, 95 % CI).

Conclusions

PE is inaccurate in identifying SPs in PTT. The increased reliance on advanced radiological imaging and the subsequent reduced emphasis on PE may have contributed to rapid deskilling amongst surgical residents. The importance of PE must be repeatedly re-emphasised.

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Conflict of interest

Victor Kong, Benn Sartorius and Damian Clarke declare that they have no conflict of interest.

Compliance with ethics guidelines

Victor Kong, Benn Sartorius and Damian Clarke declare that all procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa

    V. Y. Kong, B. Sartorius & D. L. Clarke

  2. Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa

    B. Sartorius

Authors
  1. V. Y. Kong
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  2. B. Sartorius
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  3. D. L. Clarke
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Correspondence to V. Y. Kong.

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Kong, V.Y., Sartorius, B. & Clarke, D.L. The accuracy of physical examination in identifying significant pathologies in penetrating thoracic trauma. Eur J Trauma Emerg Surg 41, 647–650 (2015). https://doi.org/10.1007/s00068-014-0484-6

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  • DOI: https://doi.org/10.1007/s00068-014-0484-6

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