Thoracic ultrasound for the diagnosis of pneumonia in adults: a meta-analysis (original) (raw)
Related papers
Clinical application of transthoracic ultrasonography in inpatients with pneumonia
European Journal of Clinical Investigation, 2010
Purpose The aim of this study was to investigate the clinical applicability of transthoracic ultrasound (TUS) in the diagnosis and follow-up of community acquired pneumonia (CAP). Methods We designed a pilot study in 15 patients and subsequently investigated 342 patients (206 men and 136 women) consecutively admitted to our Department from September 2005 to November 2009 because of radiographically diagnosed CAP. All patients underwent standard chest radiography, and consequently TUS. Follow-up TUS were performed at 4th and 8-10th day, in most patients. Results Concerning the reproducibility of TUS method, no reader's bias was present (P = 0AE18), overall variability and between-subject variability (inter-reader agreement) did not show any difference between readers (P = 0AE62 and P = 0AE32 respectively), and estimated within-subject variabilities (intra-reader agreement) suggested a very high repeatability of the method (P 1). Of 342 patients with Rx diagnosis of CAP, in 314 patients (92% of cases) a pulmonary consolidation was also detected using TUS, whose ultrasonographic patterns were studied. Pleural effusion was detected in 120 ⁄ 342 (35%) patients using ultrasound and in 111 ⁄ 342 (32%) patients using chest radiography. Overall dimensional changes of the lung consolidated areas assessed with TUS method showed highly significant results. (1st day mean ± SD: 66AE34 ± 19AE25; 4th day: 39AE92 ± 14AE61; 8-10th day: 7AE41 ± 1AE50; P < 0AE0001). Conclusions TUS is easily reproducible and we proved it to be a useful complementary diagnostic tool for the diagnosis and the follow-up of CAP.
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.
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.
Scientific Reports
Pneumonia results in significant morbidity and mortality worldwide. However, chest radiography may not be accessible in primary care setting. We aimed to evaluate clinical features and its diagnostic value to identify pneumonia among adults in primary care settings. Three academic databases were searched and included studies that assessed clinical predictors of pneumonia, adults without serious illness, have CXR and have conducted in primary care settings. We calculated sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio of each index test and the pool estimates for index tests. We identified 2,397 articles, of which 13 articles were included. In our meta-analysis, clinical features with the best pooled positive likelihood ratios were respiratory rate ≥20 min −1 (3.47; 1.46-7.23), temperature ≥38 °C (3.21; 2.36-4.23), pulse rate >100 min −1 (2.79; 1.71-4.33), and crackles (2.42; 1.19-4.69). Laboratory testing showed highest pooled positive likelihood ratios with pCt >0.25 ng/ml (7.61; 3.28-15.1) and CRP > 20 mg/l (3.76; 2.3-5.91). Cough, pyrexia, tachycardia, tachypnea, and crackles are limited as a single predictor for diagnosis of radiographic pneumonia among adults. Development of clinical decision rule that combine these clinical features together with molecular biomarkers may further increase overall accuracy for diagnosis of radiographic pneumonia among adults in primary care setting. Pneumonia is an infection of the lungs caused by bacteria, virus or fungi. It is a leading cause of morbidity and mortality worldwide, especially in elder patients and patients with comorbidities. Globally, 3.2 million of the 56.4 million deaths in 2015 were cauesd by lower respiratiry tract infection 1. The annual incidence of pneumonia was estimated at 1.07-1.2 cases per 1,000 persons per year in Europe and 16.9 cases per 1,000 persons per year in Asia 2. Diagnosis of pneumonia in adults presenting with signs of lower respiratory tract infection is important because it requires specific treatment and follow up. Pneumonia is usually diagnosed by a combination of clinical history, physical examination and/or laboratory tests. According to most clinical guidelines globally, the supposed gold standard tool for diagnosing pneumonia is a chest X-ray (CXR) which can distinguish pneumonia from other respiratory tract infections 3,4. Other diagnostic tests such as laboratory tests (white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin), blood culture, serology, and computed tomography scan (CT scan) have been reported with different rates of accuracy 5,6. However, chest radiography and other diagnostic procedures, such as sputum and blood cultures, may not be accessible or not routinely measured in primary care setting for economic and logistic reasons. The superior gold standard, CT scan, is very far from available in primary care patients. Therefore, primary care physicians usually rely on patient's medical history and physical examinations to diagnose or exclude pneumonia. Similarly, performing CXR to all suspected pneumonia cases is also challenging in the community and thereby will not always be performed for all patients. This then necessitate the need for decision aids for ordering CXR for pneumonia in the community to assess the risk more appropriately. Several prediction rules have been identified to improve detection of pneumonia in outpatient settings 7-13. Only one study of systematic review and meta-analysis to assess the diagnostic value of clinical features to identify
The Accuracy of Lung Ultrasonography Diagnosis of Community-Acquired Pneumonia, in an Adult Cohort
Journal of Diagnostic Medical Sonography, 2023
Objective: Community-acquired pneumonia (CAP) is a common respiratory infection, and diagnosis is frequently performed using a chest radiography (CXR). Sonography is an available method with less radiation exposure, but has not been confirmed for diagnosis of CAP. The objective was to compare the diagnostic accuracy of sonography. Materials and Methods: In this cross-sectional study, 90 adult patients (aged >18 years) were admitted to the emergency department of two university-affiliated hospitals in Southwest Iran, from July to December 2019, with a confirmed diagnosis of CAP. The patient symptoms and CXR results were included as part of this study. Within 24 hours after obtaining a CXR, a lung ultrasonogram (LUS) was performed. The diagnostic accuracy of semiquantitative LUS (SQLUS) was compared with CXR results using the Pearson chi-square test and Fisher’s exact test. Results: The mean age of participants was 52.98 ± 16.77 years. 51 were men (56.7%). 28 patients (31.1%), who ...
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.
Indian Journal of Critical Care Medicine
Background: Clinical pulmonary infection score (CPIS) is an established diagnostic parameter for ventilator-associated pneumonia (VAP). Lung ultrasound (LUS) is an evolving tool for diagnosing VAP. Various scores have been proposed for the diagnosis of VAP, taking LUS as a parameter. We proposed whether replacing LUS with chest radiograph in CPIS criteria will add to the diagnosis of VAP. The current study was done to evaluate the diagnostic accuracy of LUS alone and in combination with clinical and microbiological criteria for VAP by replacing chest radiograph with LUS in CPIS. Materials and methods: We conducted a prospective single-center observational study including 110 patients with suspected VAP to investigate the diagnostic accuracy of LUS. Quantitative mini-bronchoalveolar lavage (mini-BAL) culture was considered the gold standard for diagnosis of VAP. Here, the authors have explored the combination of LUS, clinical, and microbiology parameters for diagnosing VAP. On replacing chest radiograph with LUS, sono-pulmonary infection score (SPIS) and modified SPIS (SPIS-mic, SPIS-cult) was formulated as a substitute for CPIS. Results: Overall LUS performance for VAP diagnosis was good with sensitivity, specificity, positive or negative predictive value, and positive or negative likelihood ratios of 91.3%, 70%, 89%, 75%, 3, and 0.1, respectively. Adding microbiology culture to LUS increased diagnostic accuracy. The area under the curve for SPIS and modified SPIS were 0.808, 0.815, and 0.913, respectively. Conclusions: The diagnosis of VAP requires agreement between clinical, microbiological, and radiological criteria. Replacing chest radiograph with LUS in CPIS criteria (SPIS) increases diagnostic accuracy for VAP. Adding clinical and culture data to SPIS provided the highest diagnostic accuracy. Clinical parameters along with lung ultrasound increase diagnostic accuracy for VAP.