Chest wall trauma refers to a number of medical issues such as rib and sternum fractures, pulmonary bruising, and injury to chest organs by way of blunt force. Patients who have a chest wall trauma and as a result are hospitalized in the intensive care unit (ICU) have a high risk for developing complications.

Sam Speroni, a fourth-year student at the Virginia Tech Carilion School of Medicine (VTCSOM), has researched whether using bedside lung ultrasounds on ICU patients with chest trauma could reliably predict a patient’s medical trajectory.

“We wanted to figure out if there’s information we could gather that would help us predict which patients were at higher risk for developing more medical issues,” Speroni said.

Speroni’s four-year research project earned her a Letter of Distinction at the school’s 2024 Student Research Symposium.

Project overview

 

Patients over the age of 18 who were admitted to Carilion Roanoke Memorial Hospital’s ICU with chest wall trauma received bedside lung ultrasounds at established intervals while they were hospitalized.

“At VTCSOM, we have an amazing portable ultrasound curriculum, so I felt very comfortable administering the ultrasounds and reading the results,” Speroni said.

Preliminary analysis of 20 patients and 61 scans included 17 men and three women ages 23-90. The ultrasounds of 16 patients showed changes in the readings at various intervals. And 35 percent of the patients developed complications.

Speroni’s data gathering is ongoing until enough patients have been studied to achieve statical power to see if the results are significant.

“Sam’s project is especially interesting as she studies how lung ultrasound findings change over time in these patients,” said Emily Faulks, associate professor of surgery at the medical school and surgeon at Carilion Clinic. “This hasn’t really been evaluated before.”

Findings

Speroni was expecting to see clear-cut patterns in the lung ultrasound readings. Instead, the readings were unpredictable. For example, a patient who seemed to be doing well would suddenly develop a complication. Other times, someone would get better and be sent home before the required intervals of lung ultrasounds had been completed.

Another surprise was how difficult and time-consuming the data collection process was.

“The hospital sees about 200 of these types of patients each year, so I didn’t think it would be a challenge to test the number needed for statistical significance. Instead, the process of identifying patients, administering the ultrasounds at the right intervals, having two additional people verify the readings, and analyze results was a tedious process,” she said.

Significance of research

The significance of the project to date is that it presents another way to monitor these patients who are potentially at risk for complications.

“As physicians we always like to have more tools in our tool belt,” Speroni said. “If we suspect maybe a patient is going downhill, doing a lung ultrasound might be a way of confirming that suspicion.”

Speroni said further data collection and analysis could be used to develop an algorithm to help determine which patients are at risk.

Next steps

Speroni hopes to pursue surgery as a specialty when she graduates in May.

“While this project wasn’t necessarily surgical in nature, a lot of the patients in the study were potential surgery patients or already had surgery and were being managed through the ICU. This project has been a great experience. I’ve benefitted personally from it,” she said.

Speroni presented her preliminary findings at the Virginia-North Carolina Society for Critical Care Medicine.

“Sam is a highly effective researcher,” Faulks said. “She has risen to the many challenges of this project and has showcased our findings very well. She will be someone to look out for as she continues in her medical career.”

 

 

 

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