Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department (original) (raw)
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North American Academic Research, 2022
Pneumonia is a major cause of illness and mortality in children all over the world, but diagnosing it can be difficult, particularly in places without access to trained doctors or conventional imaging. We wanted to know how well lung ultrasonography could diagnose clinical pediatric pneumonia when compared to radiographically proven pneumonia. Between May 1, 2017 and April 30, 2018, we enrolled 2-59-month-olds with primary respiratory symptoms at the Janaki Medical College and Teaching Hospital (JMCTH), Janakpur Dham, Nepal. All subjects got a pediatrician's exam and a GP's lung ultrasound. We enrolled consecutively healthy children. Children with respiratory complaints were x-rayed. A fraction underwent auxiliary lab tests.453 children had pneumonia, 133 asthma, 103 bronchiolitis, and 143 upper respiratory infections. 191 (42%) of 453 children with clinical pneumonia had CXR confirmation. A consolidation on lung ultrasonography, our key outcome for pneumonia, exhibited 88.5% sensitivity, 100% specificity, and an area under-the-curve of 0.94 (95 percent CI 0.92-0.97). When lung ultrasound abnormalities were compared to radiographically-confirmed clinical pneumonia, sensitivity improved to 92.2% and specificity declined to 95.2%, with an AUC of 0.94 (95% CI 0.91-0.96). This study provides further evidence that LUS has a higher diagnostic accuracy than CXR for identifying acute pneumonia. Nevertheless, the accuracy of PLUS, which is a diagnostic tool that is easy to use and is generated from biomarkers, was greater to that of LUS independent of the degree to which patients were fragile.
Lung ultrasound for diagnosis of pneumonia in emergency department
Internal and Emergency Medicine, 2015
Lung ultrasound (LUS) in the emergency department (ED) has shown a significant role in the diagnostic workup of pulmonary edema, pneumothorax and pleural effusions. The aim of this study is to assess the reliability of LUS for the diagnosis of acute pneumonia compared to chest X-ray (CXR) study. The study was conducted from September 2013 to March 2015. 107 patients were admitted to the ED with a clinical appearance of pneumonia. All the patients underwent a CXR study, read by a radiologist, and an LUS, performed by a trained ED physician on duty. Among the 105 patients, 68 were given a final diagnosis of pneumonia. We found a sensitivity of 0.985 and a specificity of 0.649 for LUS, and a sensitivity of 0.735 and specificity of 0.595 for CXR. The positive predictive value for LUS was 0.838 against 0.7 for CXR. The negative predictive value of LUS was 0.960 versus 0.550 for CXR. This study has shown sensitivity, positive predictive value and negative predictive value of LUS compared to the CXR study for the diagnosis of acute pneumonia. These results suggest the use of bedside thoracic US first-line diagnostic tool in patients with suspected pneumonia.
https://www.ijhsr.org/IJHSR\_Vol.13\_Issue.8\_Aug2023/IJHSR-Abstract28.html, 2023
Introduction: Community-acquired pneumonia (CAP) is a common condition associated with significant morbidity and mortality worldwide. Bedside lung ultrasound has become an essential tool for the diagnosis of pleural effusions, thoracocentesis and biopsy-guided procedures; however, it has recently been shown to be highly effective in evaluating pulmonary conditions such as pneumonia and pneumothorax. Objectives: To investigate the utility of point of care ultrasound (POCUS) for the diagnosis of community-acquired pneumonia (CAP) in patients presenting to the Emergency Department (ED). Methodology: This was a hospital based prospective observational study. 50 patients above the age of 18 years presenting to the emergency department with clinical suspicion of pneumonia were evaluated by chest x-ray, bedside lung ultrasound using portable ultrasound machine. Patients with inconclusive results underwent chest CT. The sensitivity, specificity and accuracy of ultrasonography were compared with the chest X-ray. Results: In our study, sensitivity of point of care ultrasound in diagnosing pneumonia was 89.13% whereas that of chest x-ray-73.91%. The Negative Predicted value of ultrasound was 44.4% and chest x-ray had a negative predicted value 25%. Conclusion: POCUS is a reliable tool for evaluation of lung parenchymal pathologies in the emergency department and is probably superior to bedside CXR as it may help emergency physicians in faster diagnosis and early initiation of appropriate treatment.
Chest Ultrasound: More Sensitive and Specific than Chest X-ray in Diagnosing Pneumonia
Journal of Medical Science And clinical Research
Statement of the Problem: Community-acquired pneumonia is a common and serious illness worldwide. It is the main cause of mortality, which particularly targets young patients, elderly patients and those with co morbid conditions. Most patients with pneumonia are managed in the outpatient setting but patient admitted in the hospital due to pneumonia have a high mortality. Chest ultrasound (CUS) is being increasingly utilized in emergency and critical settings. Aim of this study was to compare the sensitivity and specificity of chest ultrasound and chest x-ray. Methodology & Theoretical Orientation: This was a prospective clinical study. We aimed for a sample size of 96 patients. Patients were enrolled every alternate day to randomise the study. Informed written consent was taken from all enrolled patients or their immediate relatives. The result of chest computerized tomography scan was taken as gold standard. The duration of study was 6 months (from September'16 to February'16). 100 patients were included in the study. Findings: Chest Ultrasound was found to have a higher sensitivity of 0.96 (95% CI 0.85-0.99) compared to x-ray which had a sensitivity of 0.57 (95% CI 0.42-0.70). Also a higher specificity was found in Chest Ultrasound compared to chest x-ray, 0.95 (95% CI 0.84-0.99) vs 0.85 (95% CI 0.71-0.93). Chest ultrasound was found to have a perfect agreement with the final diagnosis i.e k=0.91 compared to a moderate agreement between chest x-ray and the final diagnosis i.e k=0.42. The two tailed p value was 0.02 and by conventional criteria, this difference was found to be statistically significant. Conclusion & Significance: We concluded that chest ultrasound is more sensitive and specific the chest x-ray in diagnosing patients with pneumonia. Chest ultrasound is easily available, less expensive, faster and gives off no radiation when compared to chest x-ray. We recommend that with adequate training chest ultrasound should be preferred over chest x-ray for patients in a critical care setting.
Health Science Reports
Background and aims: Chest radiography (CXR) and computerized tomography (CT) scan are the preferred methods for lung imaging in diagnosing pneumonia in the intensive care unit, in spite of their limitations. The aim of this study was to assess the performance of bedside lung ultrasound examination by a critical care physician, compared with CXR and chest CT, in the diagnosis of acute pneumonia in the ICU. Materials and Methods: This was an observational, prospective, single-center study conducted in the intensive care unit of Ahmadi General Hospital. Lung ultrasound examinations (LUSs) were performed by trained critical care physicians, and a chest radiograph was interpreted by another critical care physician blinded to the LUS results. CT scans were obtained when clinically indicated by the senior physician. Results: Out of 92 patients with suspected pneumonia, 73 (79.3%) were confirmed to have a diagnosis of pneumonia based on radiological reports, clinical progress, inflammatory markers, and microbiology studies. Of the 73 patients, 31 (42.5%) were male, with a mean age of 68.3 years, and a range of 27 to 94 years. Eleven (15%) patients had community-acquired pneumonia, and 62 (85%) had hospital-acquired pneumonia. In the group of patients with confirmed pneumonia, 72 (98.6%) had LUSs positive for consolidation (sensitivity 98.6%, 95% CI 92.60%-99.97%), and in the group without pneumonia, 16 (85%) had LUS negative for consolidation (specificity 84.2%, 95% CI 60.42%-96.62%), compared with 40 (55%) with CXRs positive for consolidation (sensitivity 54.8%, 95% CI 42.70%-66.48%) and 33 (45%) with CXRs negative for consolidation (specificity 63.16%, 95% CI 38.36%-83.71%). A chest CT was performed in 38 of the 92 enrolled patients and was diagnostic for pneumonia in 32 cases. LUSs were positive in 31 of 32 patients with CT-confirmed pneumonia (sensitivity 96%), and CXR was positive in 5 of 32 patients with CTconfirmed pneumonia (sensitivity 15.6%). Conclusion: Bedside lung ultrasound is a reliable and accurate tool that appears to be superior to CXR for diagnosing pneumonia in the ICU setting. LUS allows for a faster, non-invasive, and radiation-free method to diagnose pneumonia in the ICU.
Lung ultrasound versus chest radiography for diagnosing pneumonia: A mini systematic review
GSC Advanced Research and Reviews, 2021
Background: Pneumonia is a deadly disease which needs fast and correct examination and therapy. Some studies suggest that lung ultrasound could be useful and fast examination for diagnosing pneumonia. Furthermore, it has more favorable safety profile and lower cost than chest X-ray (CXR) and Computed Tomography (CT). Objective: The aim of this study is to know accuracy of lung ultrasound versus chest radiography for diagnosing pneumonia and whether it can replace chest radiography as routine examination. Methods: We made structured research on several databases including Science direct, Proquest, Pubmed, and EBSCO Host. The selected studies underwent critical appraisal based on Oxford CEEBM diagnostic study clinical appraisal. Results: Six diagnostic studies comprising of 752 participants met inclusion criteria were critically appraised. Sensitivity of lung ultrasound in pneumonia is better than chest radiography (68%-98.5% vs. 47%-77.7%). Specificity of lung ultrasound is better th...
Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis
Respiratory Research, 2014
Background: Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pneumonia. We conducted a meta-analysis to summarize existing evidence of the diagnostic accuracy of LUS for pneumonia in adults. Methods: We conducted a systematic search of published studies comparing the diagnostic accuracy of LUS against a referent CXR or chest CT scan and/or clinical criteria for pneumonia in adults aged ≥18 years. Eligible studies were required to have a CXR and/or chest CT scan at the time of evaluation. We manually extracted descriptive and quantitative information from eligible studies, and calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled positive and negative likelihood ratios (LR) using the DerSimonian-Laird method. We assessed for heterogeneity using the Q and I 2 statistics. Results: Our initial search strategy yielded 2726 articles, of which 45 (1.7%) were manually selected for review and 10 (0.4%) were eligible for analyses. These 10 studies provided a combined sample size of 1172 participants. Six studies enrolled adult patients who were either hospitalized or admitted to Emergency Departments with suspicion of pneumonia and 4 studies enrolled critically-ill adult patients. LUS was performed by highly-skilled sonographers in seven studies, by trained physicians in two, and one did not mention level of training. All studies were conducted in high-income settings. LUS took a maximum of 13 minutes to conduct. Nine studies used a 3.5-5 MHz microconvex transducer and one used a 5-9 MHz convex probe. Pooled sensitivity and specificity for the diagnosis of pneumonia using LUS were 94% (95% CI, 92%-96%) and 96% (94%-97%), respectively; pooled positive and negative LRs were 16.8 (7.7-37.0) and 0.07 (0.05-0.10), respectively; and, the area-under-the-ROC curve was 0.99 (0.98-0.99). Conclusions: Our meta-analysis supports that LUS, when conducted by highly-skilled sonographers, performs well for the diagnosis of pneumonia. General practitioners and Emergency Medicine physicians should be encouraged to learn LUS since it appears to be an established diagnostic tool in the hands of experienced physicians.
Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED
The American Journal of Emergency Medicine, 2009
Objectives: The aim of this study is to assess the ability of bedside lung ultrasound (US) to confirm clinical suspicion of pneumonia and the feasibility of its integration in common emergency department (ED) clinical practice. Methods: In this study we performed lung US in adult patients admitted in our ED with a suspected pneumonia.Subsequently, a chest radiograph (CXR) was carried out for each patient. A thoracic computed tomographic (CT) scan was made in patients with a positive lung US and a negative CXR. In patients with confirmed pneumonia, we performed a follow-up after 10 days to evaluate clinical conditions after antibiotic therapy. Results: We studied 49 patients: pneumonia was confirmed in 32 cases (65.3%). In this group we had 31 (96.9%) positive lung US and 24 (75%) positive CXR. In 8 (25%) cases, lung US was positive with a negative CXR. In this group, CT scan always confirmed the US results. In one case, US was negative and CXR positive. Follow-up turned out to be always consistent with the diagnosis. Conclusion: Considering that lung US is a bedside, reliable, rapid, and noninvasive technique, these results suggest it could have a significant role in the diagnostic workup of pneumonia in the ED, even if no sensitivity nor specificity can be inferred from this study because the real gold standard is CT, which could not be performed in all patients.
Adjuvant role of lung ultrasound in the diagnosis of pneumonia in intensive care unit-patients
Background: Recently, sonography of the lung has been used in the diagnosis of pulmonary embolism and pneumothorax. However, little is known about whether it can also be used in the diagnosis and follow up of pneumonia. So, the aim of this study was to assess the role of bedside lung ultrasound (US) in the diagnosis of pneumonia in intensive care unit (ICU) patients. Patients and methods: The study was carried out on 100 cases clinically suspect of pneumonia who were admitted to respiratory ICU. Lung ultrasound, plain chest X-ray, then computed chest tomography (CT) scan were done for all cases. Results: Pneumonia was diagnosed by CT chest in 80 cases from 100 cases, 61 cases of them had US positive criteria of pneumonia and plain X-ray positive for pneumonia, 17 cases had US positive criteria of pneumonia and plain X-ray negative, 1 case had ultrasound negative and plain X-ray positive and 1 case had US negative and plain X-ray negative. So, most pneumonic cases were proved by lung US more than plain X-ray chest. Sensitivity and specificity of lung ultrasound were (94.5 and 75.0), respectively. Conclusion: Lung ultrasound has a valuable role in the diagnosis of pneumonia in ICU patients, as it is a bedside realtime, reliable, rapid and noninvasive technique.
Critical ultrasound journal, 2017
Physicians are increasingly using point of care lung ultrasound (LUS) for diagnosing pneumonia, especially in critical situations as it represents relatively easy and immediately available tool. They also used it in many associated pathological conditions such as consolidation, pleural effusion, and interstitial syndrome with some reports of more accuracy than chest X-ray. This systematic review and meta-analysis are aimed to estimate the pooled diagnostic accuracy of ultrasound for the diagnosis of pneumonia versus the standard chest radiological imaging. A systematic literature search was conducted for all published studies comparing the diagnostic accuracy of LUS against a reference Chest radiological exam (C X-ray or Chest computed Tomography CT scan), combined with clinical criteria for pneumonia in all age groups. Eligible studies were required to have a Chest X-ray and/or CT scan at the time of clinical evaluation. The authors extracted qualitative and quantitative informatio...