Transoesophageal echocardiography for diagnosis of post-traumatic Injuriesto major intrathoracic vessels in 150 patients: influence of learning curve.

Objectives: To evaluate the role of transoesophageal echocardiography (TOE) in the management of patients with suspected traumatic lesions of the thor acic aorta (TLA) and its branches; to assess the influence of the learning curve on the diagnostic accuracy of TOE for the identification of TLA. Study design: Retrospective study. Patients: The study included 150 patients (age: 41 +/- 17; Injury Severity Scale score: 31 +/- 17) who were admitted during a 4-year period for severe blunt chest trauma and who underwent a TOE study. Methods: TOE were performed with either a monoplane (n = 54) or a multiplan e probe (n = 96). In all cases, TLA were confirmed by angiography, computed tomography, surgery, or necropsy. Initially performed routinely, angiograp hy was subsequently indicated when the TOE study was inconclusive or when a disruption of supraaortic arteries was suspected. Echocardiographic studie s were reviewed by an experienced reader who was unaware of the medical his tory and initial conclusions. To evaluate the influence of the learning cur ve on the diagnostic accuracy of TOE, these conclusions were compared with the initial interpretations. Results: A TLA was recognized in 25 patients out of 150 (17%), and evidence d using TOE in 22 of them. Three false negative and two false positive TOE results (needless thoracotomy) were recorded. After a learning period, the rate of inconclusive TOE studies decreased (18/150 vs 7/150: P < 0.05) and no false positive finding was recorded. The sensitivity and specificity of TOE for the diagnosis of TLA were 88 and 100%, and positive and negative pr edictive values were 100 and 97%, respectively. Conclusions: TOE is an accurate imaging technique for the diagnosis of TLA located at the aortic isthmus. However aortography becomes essential when i njuries of the aorta branches are suspected. A learning period is required to improve the specificity of TOE for this indication. (C) 1998 Elsevier, P aris.