Bedside lung ultrasound in the diagnosis of pneumonia in very old patients (original) (raw)
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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 in the Diagnosis and Follow-up of Community-Acquired Pneumonia
CHEST Journal, 2012
The aim of this prospective, multicenter study was to defi ne the accuracy of lung ultrasound (LUS) in the diagnosis of community-acquired pneumonia (CAP). Methods: Three hundred sixty-two patients with suspected CAP were enrolled in 14 European centers. At baseline, history, clinical examination, laboratory testing, and LUS were performed as well as the reference test, which was a radiograph in two planes or a low-dose CT scan in case of inconclusive or negative radiographic but positive LUS fi ndings. In patients with CAP, follow-up between days 5 and 8 and 13 and 16 was scheduled.
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.
Emergency Medicine Journal, 2012
Objective The aim of this study was to evaluate the diagnostic accuracy of bedside lung ultrasound and chest radiography (CXR) in patients with suspected pneumonia compared with CT scan and final diagnosis at discharge. Design A prospective clinical study. Methods Lung ultrasound and CXR were performed in sequence in adult patients admitted to the emergency department (ED) for suspected pneumonia. A chest CT scan was performed during hospital stay when clinically indicated.
World Journal of Radiology, 2016
Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment's suitability are not always and everywhere affordable or accessible. TUS is complementary imaging