Diagnostic Value Of US, X-ray And CT For Thoracic Cavity Hemorrhage: A Meta-analysis And US Quantitative Diagnosis Of Haemothorax

Part Ⅰ Diagnostic value of US,X-ray,CT and RBC,Hb,HCT for thoracic cavity hemorrhage: a Meta-analysisObjectiveTo systematically review the diagnostic value of US,X-ray,CT,RBC,Hb and HCT for thoracic cavity hemorrhage caused by chest trauma.MethodsDatabases including The Cochrane Library,PubMed,Science Citation Index,EMBASE,CNKI,CBM,VIP,WanFang Data were searched for diagnostic tests for thoracic cavity hemorrhage caused by chest trauma from inception to Nov,2017.Using Google academic supplementary retrieval.Two reviewers independently screened literature,extracted data and assessed the methodological quality of included studies by the QUADAS tool.Meta-analysis was analyzed by Meta-Disc 1.4,Stata 14.0 and RevMan 5.3 softwares.ResultsThere were retrieved 7761 anticles.A total of 27 articles met the inclusion and exclusion criteria.There were 26 studies related to imaging indicators,including 16 articles about US,15 articles about X-ray and 5 articles about CT.Only 1 study was laboratory test indicators,which was excluded from single research.A total of 26 studies involving 10402 patients and10846 samples were included.All the studies were imaging examination,The quality of all the involved studies was moderate,the proportion of high-risk bias items was about 19.23%and mainly case patients selection.The risk bias of index text and reference standard were in moderate,the proportion of medium risk were 26.92% and 15.38%.The prospective study accounted for 57.69% and the small sample volume studies(n<100)accounted for 26.92%.The result of Meta-analysis showed that using chest US can judge accurately whether intrathoracic hemorrhage.When to determine whether the intrathoracic bleeding by X-ray need to be cautious because the missed rate as high as 41%.CT could accurately judge whether intrathoracic blood.The indirect comparison of the results of Meta-analysis showed that when US and X-ray compare common gold standard as CT,accuracy of the US was superior to X-ray diagnosis of intrathoracic hemorrhage.When US and X-ray with surgery asthe gold standard,specificity of US in intrathoracic hemorrhage was superior to X-ray.There were no significant difference in other indicators of diagnostic value.When X-ray and CT with surgery as the common gold standard,the result said CT of accuracy was superior to X-ray diagnosis of intrathoracic hemorrhage.When US and CT with surgery as the gold standard for common,there were no significant diference of US and CT in diagnosis of the pleural hemorrhage patients.Part Ⅱ The value of the maximum depth of US quantitative diagnosis of haemothoraxObjectiveTo investigate the feasibility of ultrasonography quantitative assessment of haemothorax.MethodsRetrospective studay all hemothorax medical records of ultrasound from July 2007 to July 2017 in department of thoracic surgery,hospital of lanzhou army,recording the index of the distance of skin puncture,the maximum depth,check intercostal space,puncture intercostal space,discharge volume and drainage time.Then performe multivariate linear regression analysis.Finding indicators related to thoracic drainage.ResultsA total of 37 patients with 54 operation was included in this study.There were divided into the puncture group(n=33),the puncture tube drainage group(n=8)and the thoracic close drainage group(n=13)according to the different drainage methods.There was no significant difference of gender,age,the distance of skin puncture in the three groups(p>0.05).There were no statistically significant differences in hospitalization time,distance of skin puncture,intercostal space and maximum depth under ultrasound examination,volume of drainage,total volume of drainage and drainage time of the puncture tube drainage group and the thoracic close drainage group(p>0.05).Multiple linear regression analysis showed that the correlation between the flow rate and the maximum depth in the anechoic region was significant(p=0.00),and the correlation coefficient was r=0.44.The fitted regression equation was Y=107.53+84.41 X.Conclusions(i)Through indirect comparison of Meta analysis,the diagnostic value of diagnosis hemathorax imaging index sorted was: CT > US > X-ray.(ii)The diagnostic value of hemothorax was similar to CT and US.But for the patients with limited position or critically ill,using US instead of CT was a simple and rapid diagnosis and more timely treatment.(iii)US quantitative assessment of haemothorax was suitable for clinicians to guide the clinical diagnosis and treatment patients timely accurate estimation of the amount of hemothorax.Using puncture tube drainage instead of thoracic close drainage could achieve well drainage,and fewer unnecessary pain of hemothorax patients who with stable vital signs.