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J Ultrasound Med. 2018 Nov;37(11):2681-2687. doi: 10.1002/jum.14629. Epub 2018 Apr 24.

Does the Addition of M-Mode to B-Mode Ultrasound Increase the Accuracy of Identification of Lung Sliding in Traumatic Pneumothoraces?

Author information

1
Department of Emergency Medicine, University of Kentucky, Lexington, Kentucky, USA.
2
Department of Emergency Medicine, University of Tennessee, Chattanooga, Tennessee, USA.
3
Department of Emergency Medicine, Central Michigan University, Mount Pleasant, Michigan, USA.
4
Department of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA.

Abstract

OBJECTIVES:

It is unknown whether the addition of M-mode to B-mode ultrasound (US) has any effect on the overall accuracy of interpretation of lung sliding in the evaluation of a pneumothorax by emergency physicians. This study aimed to determine what effect, if any, this addition has on US interpretation by emergency physicians of varying training levels.

METHODS:

One hundred forty emergency physicians were randomized via online software to receive a quiz with B-mode clips alone or B-mode with corresponding M-mode images and asked to identify the presence or absence of lung sliding.

RESULTS:

The sensitivity, specificity, and accuracy of the diagnosis of lung sliding with and without M-mode US were compared. Overall, the sensitivities, specificities, and accuracies of B-mode + M-mode US versus B-mode US alone were 93.1% and 93.2% (P = .8), 96.0% and 89.8% (P < .0001), and 91.5% and 94.5% (P = .0091), respectively. A subgroup analysis showed that in those providers with fewer than 250 total US scans done previously, M-mode US increased accuracy from 88.2% (95% confidence interval, 86.2%-90.2%) to 94.4% (92.8%-96.0%; P = .001) and increased the specificity from 87.0% (84.5%-89.5%) to 97.2% (95.4%-99.0%; P < .0001) compared with B-mode US alone. There was no statistically significant difference observed in the sensitivity, specificity, and accuracy of B-mode + M-mode US compared with B-mode US alone in those with more than 250 scans.

CONCLUSIONS:

The addition of M-mode images to B-mode clips aids in the accurate diagnosis of lung sliding by emergency physicians. The subgroup analysis showed that the benefit of M-mode US disappears after emergency physicians have performed more than 250 US examinations.

KEYWORDS:

chest/lung; emergency medicine; pneumothorax; trauma; ultrasound

PMID:
29689594
DOI:
10.1002/jum.14629
[Indexed for MEDLINE]

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