ﺗﺸﺨﯿﺺ آﻣﻔﯿﺰم زﯾﺮ ﺟﻠﺪي در ﺗﺮوﻣﺎي ﻏﯿﺮ ﻧﺎﻓﺬ ﻗﻔﺴﻪ ﺳﯿﻨﻪ: اﻫﻤﯿﺖ ﺷﺮح ﺣﺎل و ﻣﻌﺎﯾﻨﻪ ﻓﯿﺰﯾﮑﯽ ﺑﺮ اﺳﺎس ﺣﺴﺎﺳﯿﺖ و اﺧﺘﺼﺎﺻﯿﺖ

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

آﻣﻔﯿﺰم زﯾﺮ ﺟﻠﺪي ﯾﮏ وﺿﻌﯿﺖ ﺑﺎﻟﯿﻨﯽ اﺳﺖ ﮐﻪ ﺑﺎ ورود ﻫﻮا ﺑﻪ ﺑﺎﻓﺖﻫﺎي ﻧﺮم زﯾﺮ ﭘﻮﺳﺖ رخ ﻣﯽدﻫﺪ. اﯾﻦ ﻋﺎرﺿﻪ ﺑﺴﺘﻪ ﺑﻪ ﻧﻮع آﺳﯿﺐ ﺷﻨﺎﺳﯽ ﻣﻤﮑﻦ اﺳﺖ در ﻫﺮ ﻗﺴﻤﺖ از ﺑﺪن رخ دﻫﺪ. ﻫﺪف از اﻧﺠﺎم ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ارزﯾﺎﺑﯽ ﺣﺴﺎﺳﯿﺖ و وﯾﮋﮔﯽ ﺷﺮح ﺣﺎل و ﻣﻌﺎﯾﻨﻪ ﻓﯿﺰﯾﮑﯽ در ﺗﺸﺨﯿﺺ آﻣﻔﯿﺰم زﯾﺮﺟﻠﺪي در ﺑﯿﻤﺎران ﺑﻼﻧﺖ ﺗﺮوﻣﺎ ﻣﯽﺑﺎﺷﺪ. روش ﮐﺎر اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﯿﻔﯽ - ﺗﺤﻠﯿﻠﯽ اﺳﺖ. ﺗﻤﺎم ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺗﺮوﻣﺎ ﺑﻼﻧﺖ ﮐﻪ ﺑﻪ ﺑﺨﺶ اورژاﻧﺲ ﺑﯿﻤﺎرﺳﺘﺎن ﭘﯿﻤﺎﻧﯿﻪ ﺷﻬﺮ ﺟﻬﺮم ﻣﺮاﺟﻌﻪ ﮐﺮده ﺑﻮدﻧﺪ از ﻧﻈﺮ ﻣﮑﺎﻧﯿﺴﻢ آﺳﯿﺐ، ﺷﮑﺎﯾﺎت اﺻﻠﯽ، ﻋﻼﺋﻢ ﺣﯿﺎﺗﯽ و اﺷﺒﺎع اﮐﺴﯿﮋن ﻣﻮرد ارزﯾﺎﺑﯽ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﺷﺮح ﺣﺎل و ﻣﻌﺎﯾﻨﻪ ﻓﯿﺰﯾﮑﯽ ﻣﻄﺎﺑﻖ ﻣﺮﺟﻊ ﺑﺎرﺑﺎراﺑﯿﺘﺰ اﻧﺠﺎم ﺷﺪ. آﻣﻔﯿﺰم ﺑﺮ اﺳﺎس ﻧﺘﺎﯾﺞ اﺷﻌﻪ X ﻗﻔﺴﻪ ﺳﯿﻨﻪ ﺗﺸﺨﯿﺺ داده ﺷﺪ. ﻧﺘﺎﯾﺞ ﺑﺎ اﺳﺘﻔﺎده از ﻣﻨﺤﻨﯽﻫﺎي ROC در ﻧﺮم اﻓﺰار SPSS ﻣﻮرد ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﻗﺮار ﮔﺮﻓﺖ. ﻧﺘﺎﯾﺞ در 3 ﻣﻮرد از 99 ﺑﯿﻤﺎر وﺟﻮد آﻣﻔﯿﺰم در ﮔﺮاﻓﯽ ﻣﺸﺎﻫﺪه ﺷﺪ. آﻧﺎﻟﯿﺰ AUC ﺿﺮﺑﺎن ﻗﻠﺐ ﻣﻌﻨﯽ دار ﺑﻮد)0/032=p(. ﺿﺮﺑﺎن ﻗﻠﺐ ﺑﺎﻻي 98/5 ﺑﺎ ﺣﺴﺎﺳﯿﺖ 17/6% و وﯾﮋﮔﯽ 66/7% ﺑﺎ آﻣﻔﯿﺰم ﻫﻤﺮاه ﺑﻮد. در ﺳﺎﯾﺮ ﺗﺴﺖﻫﺎ ﺑﯿﺸﺘﺮﯾﻦ ﺣﺴﺎﺳﯿﺖ و اﺧﺘﺼﺎﺻﯿﺖ )100%(، ﻣﺮﺑﻮط ﺑﻪ ﭘﻨﻮﻣﻮﺗﻮراﮐﺲ ﺑﻮد. ﯾﺎﻓﺘﻪ ﺟﺎﻟﺐ ﺣﺴﺎﺳﯿﺖ 100 درﺻﺪي ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﺑﺮاي آﻣﻔﯿﺰم ﺑﻮد. ﺑﻌﺪ از آن ﮐﺎﻧﺘﯿﻮژن رﯾﻮي، ﮐﺎﻫﺶ ﺻﺪاي رﯾﻮي و وﺟﻮد ﺧﺮاش در ﻗﻔﺴﻪ ﺳﯿﻨﻪ ﺑﺎ 66/7% ﺣﺴﺎﺳﯿﺖ و ﺳﭙﺲ درد، ﺗﻨﮕﯽ ﻧﻔﺲ و ﻫﻤﻮﺗﻮراﮐﺲ ﺑﺎ 33/3% در رﺗﺒﻪﻫﺎي ﺑﻌﺪي ﻗﺮار داﺷﺘﻨﺪ. ﻧﺘﯿﺠﻪ ﮔﯿﺮي ﻣﻌﺎﯾﻨﻪ ﻣﻨﺎﺳﺐ ﺑﺪﻧﯽ و ﮔﺮﻓﺘﻦ ﺗﺎرﯾﺨﭽﻪ ﻣﯽﺗﻮاﻧﺪ ﺑﻪ ﺗﺸﺨﯿﺺ آﻣﻔﯿﺰم ﺑﺎ ﺣﺴﺎﺳﯿﺖ و وﯾﮋﮔﯽ ﺑﺎﻻ ﮐﻤﮏ ﮐﻨﺪ.

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.