Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography

Nazerian, Peiman; Volpicelli, Giovanni; Vanni, Simone; Gigli, Chiara; Betti, Laura; Bartolucci, Maurizio; Zanobetti, Maurizio; Ermini, Francesca Romana; Iannello, Cristina; Grifoni, Stefano

doi:10.1016/j.ajem.2015.01.035

Cited by 182 publications

(134 citation statements)

References 36 publications

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“…Among all 14 studies, 11 were carried out in emergency department (ED) or medical wards (10,(15)(16)(17)(18)(19)(20)(22)(23)(24)(25), and 3 were conducted in intensive care unit (ICU) (14,21,26). Hemithorax was used as the study unit for result interpretation in one study (23), while others counted by patient.…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

“…For the gold standard of pneumonia diagnosis, six set chest CT as the sole criteria, six used clinical presentations together with imaging, and two studies introduced microbiology. Additionally, LUS was performed by experienced physicians in ED or ICU except one study whose ultrasound procedures were done by sonographers (25). Of note, lateral and posterior chest wall examinations were both conducted preferably in the seated position in three studies (20,24,25), while six performed posterior scan in supine or semi-recumbent position, and lateral examination in a sitting position; three studies in ICU used supine or semi-recumbent position for all scans (14,21); two studies did not specify the position (10,22) ( Table 3).…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

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Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Yang¹,

Ying²,

Wang³

et al. 2016

J. Thorac. Dis.

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Background: Pneumonia is usually presented as a forgotten killer, and an early diagnosis could largely improve the prognostic outcomes. Lung ultrasound (LUS) has been universally applied in evaluating multiple pulmonary diseases including pneumonia. However, the diagnosis accuracy of LUS for pneumonia in adults is still uncertain. Hence, we performed a systematic review of the current literature to assess the diagnosis accuracy of LUS for pneumonia in adults.Methods: PubMed and EMBASE were searched for clinical trials that assessed the detection accuracy of LUS for pneumonia in adult patients. We extracted descriptive and quantitative information from eligible studies that met strict inclusion criteria and calculated pooled sensitivity, specificity and pooled diagnostic likelihood ratios (LR). Summary receiver operating characteristic (sROC) curve was used to assess the overall performance of LUS-based assays.Results: We reviewed 1,072 articles and selected 38 for detailed review. 14 articles containing 1,911 participants met all inclusion criteria and were included in the final analysis. LUS exhibited a pooled sensitivity of 0.904 (0.884-0.921), specificity of 0.884 (0.861-0.904), positive LR of 6.6 (3.7-11.7), negative LR of 0.08 (0. 04-0.19) and the area under curve (AUC) was 0.9611. Interestingly, when CT alone, CT combined with clinical presentations, and microbiology was set as the gold standard of pneumonia respectively, LUS demonstrated a pooled sensitivity of 90.9%, 95.0%, 53.3%, and a pooled specificity of 89.7%, 91.3% and 67.9%. In extension, we compared the diagnostic efficiency of LUS for pneumonia with chest X-ray (CXR) in 1,343 patients. The AUC for LUS and CXR was 0.972 and 0.867 respectively and the Z statistic of the two sROC curves was 2.31.Conclusions: Our study indicated that LUS is a robust diagnostic tool for pneumonia with high accuracy.Utilization of LUS would facilitate the estimation of pneumonia at bedside. be based on swift and accurate recognition. The signs and symptoms localizing to the respiratory system, commonly referring as dyspnea, cough and fever, laboratory alterations (leukocytosis and increased c-reactive protein/procalcitonin) in conjunction with radiographic pulmonary infiltrate, point to convincing diagnosis of pneumonia. Imaging evaluation approaches recommended on current guidelines are chest radiograph and chest computerized tomography (CT) (2,3). However, limitations for their use exist (4). Surprisingly, a recent study compared CXR to chest CT scan for suspected CAP. They found up to 30% false positive and false negative rate of CXR in emergency department (ED), which doubted the value of CXR on pneumonia diagnosis (5). Thus, it's reasonable to figure out the alternative way to provide promising imaging evidence of pneumonia.Ultrasonography is gaining more attention in critical care and emergency medicine. A good body of studies has proven that ultrasonography is highly effective in evaluating multiple pulmonary diseases, such as metastatic lymph node of lung c...

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Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Yang¹,

Ying²,

Wang³

et al. 2016

J. Thorac. Dis.

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“…Tiene una gran utilidad para el diagnóstico de la insuficiencia cardiaca izquierda. En manos expertas la ecografía pulmonar tiene mayor precisión diagnóstica para la neumonía y el neumotórax que la radiografía de tórax [6][7][8] .…”

Section: Ecografía Pulmonarunclassified

“…En algunos estudios se ha demostrado que la ecografía, en manos expertas, tiene una exactitud diagnóstica superior a la radiografía de tórax para el diagnóstico de neumonía 6 . La fiabilidad de la radiología de tórax en el diagnóstico de la neumonía es extremadamente variable, especialmente en pacientes deshidratados, inmunocomprometidos o ancianos.…”

Section: 2 3 Neumoníaunclassified

Utilidad de la ecografía clínica en el diagnóstico del paciente con disnea

2016

Gal. Clin.

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IntroducciónLa disnea es un síntoma frecuente. Tiene una amplia variedad de posibilidades etiológicas y no siempre resulta sencillo establecer un diagnóstico correcto, especialmente en personas ancianas, obesas o en pacientes con antecedentes de enfermedad pulmonar obstructiva crónica (EPOC). La disnea puede deberse a procesos potencialmente graves en los que un diagnóstico precoz y el inicio del tratamiento médico adecuado son muy importantes 1, 2 . El desarrollo de equipos ecográficos portátiles y de gran calidad a un precio asequible ha permitido una enorme difusión de ecografía en múltiples especialidades (medicina interna, urgencias, cuidados intensivos, anestesia, reumatología, neumología, etc. ). La ecografía clínica, es decir, la realizada por el médico directamente responsable del paciente a pie de cama facilita el diagnóstico precoz del enfermo con disnea en múltiples ámbitos (urgencias, planta de hospitalización, unidades de cuidados intensivos y reanimación), incluido el medio extrahospitalario 3 . Etiología de la disneaEn la tabla 1 mostramos las causas más frecuentes de disnea. En la mayoría de los casos la disnea está relacionada con patología respiratoria o cardiaca, aunque existen diagnósticos alternativos. A pesar de una correcta valoración clínica inicial, en un porcentaje significativo de pacientes no se puede establecer con exactitud la etiología de la disnea y existen al menos dos o más posibilidades diagnósticas. De esta forma surge el concepto de "disnea indiferenciada" (tabla 2) 2 . Un reto diagnóstico, por ejemplo, es la agudización del enfermo con EPOC que puede ser debida a múltiples circunstancias (infección respiratoria, embolia de pulmón, neumotórax, insuficiencia cardiaca, cáncer de pulmón). Evaluación diagnóstica del paciente con disneaLa base del diagnóstico del enfermo con disnea se sustenta en la historia clínica y exploración física. Dependiendo de la valoración clínica inicial se solicitan, si es necesario, pruebas complementarias para esclarecer su etiología. Entre las Correspondencia:

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“…Pneumonic consolidation has more rapid and marked enhancement with sonographic contrast [54]. Consolidation may be difficult to detect when it is hidden behind bony structures [55] or does not extend to the pleura [56]. However, the latter is reportedly rare [51].…”

Section: Lung Consolidationmentioning

confidence: 99%

The efficacy of bedside chest ultrasound: from accuracy to outcomes

Hew

Tay

2016

Eur Respir Rev

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For many respiratory physicians, point-of-care chest ultrasound is now an integral part of clinical practice. The diagnostic accuracy of ultrasound to detect abnormalities of the pleura, the lung parenchyma and the thoracic musculoskeletal system is well described. However, the efficacy of a test extends beyond just diagnostic accuracy. The true value of a test depends on the degree to which diagnostic accuracy efficacy influences decision-making efficacy, and the subsequent extent to which this impacts health outcome efficacy. We therefore reviewed the demonstrable levels of test efficacy for bedside ultrasound of the pleura, lung parenchyma and thoracic musculoskeletal system.For bedside ultrasound of the pleura, there is evidence supporting diagnostic accuracy efficacy, decisionmaking efficacy and health outcome efficacy, predominantly in guiding pleural interventions. For the lung parenchyma, chest ultrasound has an impact on diagnostic accuracy and decision-making for patients presenting with acute respiratory failure or breathlessness, but there are no data as yet on actual health outcomes. For ultrasound of the thoracic musculoskeletal system, there is robust evidence only for diagnostic accuracy efficacy.We therefore outline avenues to further validate bedside chest ultrasound beyond diagnostic accuracy, with an emphasis on confirming enhanced health outcomes. @ERSpublicationsThe next challenge in bedside chest ultrasound is to refocus from diagnostic accuracy toward patient outcomes http://ow.ly/NyNR3027WLU

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Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography

Cited by 182 publications

References 36 publications

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Utilidad de la ecografía clínica en el diagnóstico del paciente con disnea

The efficacy of bedside chest ultrasound: from accuracy to outcomes

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