Diagnosis of subcutaneous emphysema in blunt thoracic trauma: Importance of history and physical examination based on sensitivity and specificity

Document Type : Research Paper

Authors

1 Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

2 Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran.

3 Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.

4 Research center for social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.

5 Department of Plastic Surgery, Jahrom University of Medical Sciences, Jahrom, Iran.

Abstract

Introduction: Subcutaneous emphysema is a clinical condition that occurs when air enters the soft tissues under the skin. The condition may occur in any part of the body depending on the pathology. The aim of this study was to evaluate the sensitivity and specificity of the history and physical examination of subcutaneous emphysema in blunt trauma patients.
Method: This is a descriptive-analytical study. All patients with blunt trauma referred to the emergency department were evaluated for the mechanism of injury, major complaints, vital signs, and oxygen saturation. History and physical examination were performed according to Barbara Bates' reference. Emphysema was diagnosed based on chest X-ray results. The results were analyzed using ROC curves in SPSS software.
Results: Emphysema was detected in 3 cases of 99 patients with mean age of 33.4 19 19 43.43. AUC analysis of heart rate was significant (P = 0.032). A heart rate above 98.5 was associated with a sensitivity of 17.6% and a specificity of 66.7% with emphysema. In other tests, pneumothorax had the highest sensitivity and specificity (100%). An interesting finding was the sensitivity of 100% rib fracture to emphysema. After that, pulmonary contusion, pulmonary noise reduction, and chest scratching were 66.7%, followed by pain, shortness of breath, and hemothorax with 33.3%.
Conclusion: Proper physical examination and history taking can help to diagnose emphysema with high sensitivity and specificity. The purpose of this study was to demonstrate the importance of this topic.

Keywords

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medical journal of mashhad university of medical sciences
Volume 63, Issue 2
July and August 2020
Pages 2408-2414

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