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Diagnostic accuracy of a novel software technology for detecting pneumothorax in a porcine model

  • Shane M. Summers
    Affiliations
    Department of Emergency Medicine, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, USA
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  • Eric J. Chin
    Affiliations
    Department of Emergency Medicine, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, USA
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  • Author Footnotes
    1 Disclaimer: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of Defense or the U.S. Government.
    Michael D. April
    Correspondence
    Corresponding author at: 3551 Roger Brooke Dr., Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio, TX 78234, USA
    Footnotes
    1 Disclaimer: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of Defense or the U.S. Government.
    Affiliations
    Department of Emergency Medicine, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, USA
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  • Ronald D. Grisell
    Affiliations
    United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
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  • Joshua A. Lospinoso
    Affiliations
    Department of Emergency Medicine, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, USA
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  • Bijan S. Kheirabadi
    Affiliations
    United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
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  • Jose Salinas
    Affiliations
    United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
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  • Lorne H. Blackbourne
    Affiliations
    United States Army Medical Department Center and School (AMEDD C&S), JBSA Fort Sam Houston, TX, USA
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  • Author Footnotes
    1 Disclaimer: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of Defense or the U.S. Government.
Published:April 01, 2017DOI:https://doi.org/10.1016/j.ajem.2017.03.073

      Abstract

      Introduction

      Our objective was to measure the diagnostic accuracy of a novel software technology to detect pneumothorax on Brightness (B) mode and Motion (M) mode ultrasonography.

      Methods

      Ultrasonography fellowship-trained emergency physicians performed thoracic ultrasonography at baseline and after surgically creating a pneumothorax in eight intubated, spontaneously breathing porcine subjects. Prior to pneumothorax induction, we captured sagittal M-mode still images and B-mode videos of each intercostal space with a linear array transducer at 4 cm of depth. After collection of baseline images, we placed a chest tube, injected air into the pleural space in 250 mL increments, and repeated the ultrasonography for pneumothorax volumes of 250 mL, 500 mL, 750 mL, and 1000 mL. We confirmed pneumothorax with intrapleural digital manometry and ultrasound by expert sonographers. We exported collected images for interpretation by the software. We treated each individual scan as a single test for interpretation by the software.

      Results

      Excluding indeterminate results, we collected 338 M-mode images for which the software demonstrated a sensitivity of 98% (95% confidence interval [CI] 92–99%), specificity of 95% (95% CI 86–99), positive likelihood ratio (LR+) of 21.6 (95% CI 7.1–65), and negative likelihood ratio (LR−) of 0.02 (95% CI 0.008–0.046). Among 364 B-mode videos, the software demonstrated a sensitivity of 86% (95% CI 81–90%), specificity of 85% (81–91%), LR+ of 5.7 (95% CI 3.2–10.2), and LR− of 0.17 (95% CI 0.12–0.22).

      Conclusions

      This novel technology has potential as a useful adjunct to diagnose pneumothorax on thoracic ultrasonography.

      Keywords

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