Clinical trial NCT06078254: Senstivity and Specificity of Lung Ultrasound for Early Detection of ARDS in Patients With Chest Trauma
Official title: Accuracy, Senstivity and Specificity of Lung Ultrasound in Comparison to CT Chest for Early Detection of ARDS and Pneumonia in Patients With Chest Trauma
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Chest Trauma
Lead sponsor: Ain Shams University
Sponsor class: OTHER
First posted: 2023-10-11
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients who admitted to critical area with chest trauma will perform both CT chest and lung ultrasound and will be followed up by ultrasound to detect any pulmonary complication and early detection of ARDS and pneumonia.

Brief summary: The aim of this study is to evaluate the accuracy, sensitivity and specificity of lung ultrasound in early detection of ARDS and Pneumonia in comparison to CT chest in patients with chest trauma. Also, we aim at finding any pulmonary complications and its correlation to development of ARDS and pneumonia in patients with chest trauma.

Detailed description: Thoracic trauma has significant morbidity and mortality. It is the fourth most common trauma site after the head, abdomen, pelvis and extremities.

Thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially.

Routine tests for chest injuries include chest X-rays and computed tomography (CT) scans. Chest X-rays are available but are insufficiently sensitive for chest trauma. Multi-detector CT is now considered the gold standard imaging tool in the emergency department; however, it is not applicable for unstable patients and is unavailable in intensive care units, so patient transport to radiology departments is required. This technique also exposes patients to high doses of ionizing radiation.

In thoracic trauma cases, ultrasonography of the lungs is valuable for evaluating various chest diseases, including chest wall hematoma and fractures, pleural cavity involvement with pleural effusion, hemothorax, and pneumothorax, and pericardial cavity involvement with hemopericardium.

The ultrasound can also assess the reduce in lung aeration in acute diseases by changing the lung surface and generating distinct patterns as in pulmonary contusions and compression atelectasis.

In pneumothorax cases, the major criterion for ultrasound diagnosis is the absence of lung sliding during a dynamic examination, as well as the absence of a pleural gap and lung point, which is the transitional area between the breath-dependent, moving lung and the pleural air column in cases of partial pneumothorax with incomplete lung collapse.

Lung contusion is the most frequent thoracic injury in blunt chest trauma and it is associated with increased morbidity and mortality. Direct damage of the lung tissue causes both local and systemic inflammatory responses that can lead to acute respiratory distress syndrome (ARDS) and multiple organ failure. The initial size of the lung contusion seems to play a key role in these mechanisms.Several CT scan studies have shown that initial lung contusion volume is predictive of the development of subsequent ARDS.

Ultrasounds aids in pleural effusion detection, even if minimal. Ultrasound can assess and quantify the amount of effusion, and characterize its internal complexity, such as septations, exudative effusion, fibrin strands, and echogenic pleural effusion.

Eligibility criteria: Inclusion Criteria:

* All ICU patients who got admitted to critical care department with chest trauma.

Exclusion Criteria:

* Pediatric patients aged less than 18 years old.
* Any patients have previous lung disease like (IPF, lung cancer, respiratory failure and pulmonary hypertension).
* Pregnant females at any gestational age

Primary outcomes:
measure: Evaluation of accuracy ,sensitivity and specificity of lung ultrasound in early detection of acute respiratory distress syndrome and pneumonia in patients with chest trauma.
timeFrame: 18 MONTHS
Secondary outcomes:
measure: Correlation between occurrence of different pulmonary complications due to chest trauma and development of ARDS and pneumonia in patients with chest trauma.
timeFrame: 18 MONTHS
Other outcomes:
Locations:
city: Cairo
country: Egypt
facility: AinShams University
Study officials:
affiliation: Ain Shams University
name: Omar M. Taha Elsafty, professor
role: STUDY_CHAIR
affiliation: Ain Shams University
name: Kareem Y. Kamal Hakim, professor
role: STUDY_DIRECTOR
affiliation: Ain Shams University
name: Amr G. Sharaf, MD
role: STUDY_DIRECTOR
affiliation: Ain Shams University
name: Eman M. Hesham Elshaer, MD
role: STUDY_DIRECTOR
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