Mar. 4, 2009 The incidence of pneumothorax (PTX), or collapsed lung, among dogs and cats with blunt and penetrating trauma has been reported to range from 13 – 50 percent, with mortality rates ranging from 10 – 18 percent. In people, PTX is reported to be the most preventable cause of death in trauma patients.
Thoracic ultrasound has been infrequently used as a non-invasive, point-of-care imaging technique to detect PTX and other thoracic injuries in veterinary trauma patients. A study recently published in the Journal of Veterinary Emergency and Critical Care developed a new thoracic ultrasound examination called TFAST (Thoracic Focused Assessment with Sonography for Trauma) to diagnose PTX and other related injury in dogs. TFAST proved to be a highly accurate method for detecting PTX and other thoracic injuries, similar to findings in human clinical research.
Findings from this veterinary study were presented at the American College of Surgeons annual meeting last October by world-renowned physician, Andrew W. Kirkpatrick, a leading specialist in human trauma care.
Dr. Kirkpatrick cited the article for exceptionally clear descriptions of the methodology and physiology that can be of concurrent importance to human surgeons. He stated: “This is a wonderful paper that evaluates an incredibly useful bedside technique that empowers the physical examination in a good sized cohort of animals with very good results. It is wonderful to see this technique come back to the veterinary world, as the very first description of using ultrasound for these purposes was in horses more than 20 years ago. Additionally, the absolutely beautiful figures accompanying the study are very illustrative and set a standard for all.”
Researchers led by veterinarian, Dr. Gregory R. Lisciandro, a specialist in veterinary emergency and critical care, evaluated 145 dogs within 24 hours of their injury which included automobile accidents and bite and gunshot wounds. High accuracy, sensitivity, and specificity was found when comparing TFAST to chest X-ray findings.
TFAST was used to successfully diagnose PTX and identify other concurrent thoracic trauma in approximately 50 percent of these dogs, of which 23 percent had PTX. Their results demonstrate the potential for TFAST in veterinary emergency medicine to rapidly detect PTX and other potentially life-threatening thoracic injuries, including rib fractures, intercostal muscle tears, diaphragmatic hernia, hemothorax, and hemopericardium advantageously upon patient presentation on the exam table during triage. The group of San Antonio emergency and critical care veterinarians has also found TFAST extremely helpful in traumatized cats as well as any dogs or cats in respiratory distress.
“The use of our TFAST protocol may expedite therapeutic intervention and life-saving maneuvers in emergent, critically ill, and high-risk patients,” the authors conclude. “Veterinarians should consider making thoracic (TFAST) and abdominal (AFAST) FAST training not only part of the core competency, but also a standard of care in management of trauma and other high-risk patients in critical care settings.”
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- Lisciandro et al. Evaluation of a thoracic focused assessment with sonography for trauma (TFAST) protocol to detect pneumothorax and concurrent thoracic injury in 145 traumatized dogs. Journal of Veterinary Emergency and Critical Care, 2008; 18 (3): 258 DOI: 10.1111/j.1476-4431.2008.00312.x
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