Bedside lung ultrasonography for diagnosis of pneumonia

Unluer, EE; Karagöz, Arıf; Senturk, GO; Karaman, Musa; Olow, KH; Bayata, Serdar

doi:10.1177/102490791302000205

Cited by 20 publications

(33 citation statements)

References 35 publications

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“…Three studies (30%) used chest CT scan as the gold standard in cases for which LUS and CXR findings were discordant [22,31,35] and four (40%) performed chest CT scan when clinically indicated [21,34,36,37]. Four studies (40%) explained reasons for study withdrawal [22,34,36,37] and only one study (10%) reported non-interpretable results [35]. Nine studies (90%) used a 3.5-5 MHz micro convex transducer [21,22,[31][32][33][34][35][36][37] and one (10%) used a 5-9 MHz convex probe [38].…”

Section: Methodological Heterogeneitymentioning

confidence: 99%

“…Four studies (40%) explained reasons for study withdrawal [22,34,36,37] and only one study (10%) reported non-interpretable results [35]. Nine studies (90%) used a 3.5-5 MHz micro convex transducer [21,22,[31][32][33][34][35][36][37] and one (10%) used a 5-9 MHz convex probe [38]. Four studies (33%) provided information regarding time to perform LUS [21,33,36,37] (Table 4).…”

Section: Methodological Heterogeneitymentioning

confidence: 99%

“…We identified 2726 studies that fit our search strategy ( Figure 1) of which 45 (1.7%) were retrieved for further evaluation based on inclusion criteria and content. After excluding commentaries, review articles, studies not fulfilling methodological criteria and studies involving children, we identified 10 studies [21,22,[31][32][33][34][35][36][37][38] for analysis: 6 studies (60%) were conducted in adult patients admitted to EDs or medical wards, and 4 studies (40%) were conducted in adult, critically-ill patients in the ICU. Two studies used lung subunits as independent observations: in one study each patient contributed information for each hemithorax [38] while in another each patient contributed information for twelve lung regions [32].…”

Section: Overview Of Literature Searchmentioning

confidence: 99%

“…Mean age was 59 years (range 18 to 95) and 60% were male. Two studies (20%) were conducted in multiple centers [22,36] while the remaining (80%) were single-center studies [21,[31][32][33][34][35]37,38]. All studies were blinded to outcome of CXR or chest CT scan prior to conduct or interpretation of LUS.…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

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Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

et al. 2014

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BackgroundGuidelines 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.MethodsWe 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 I2 statistics.ResultsOur 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 micro-convex 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).ConclusionsOur 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.

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Section: Methodological Heterogeneitymentioning

confidence: 99%

Section: Methodological Heterogeneitymentioning

confidence: 99%

Section: Overview Of Literature Searchmentioning

confidence: 99%

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

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Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

et al. 2014

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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%

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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Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era

et al. 2021

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In the coronavirus disease-2019 (COVID-19) era, point-of-care lung ultrasound (LUS) has attracted increased attention. Prospective studies on LUS for the assessment of pneumonia in adult patients were extensively carried out for more than 10 years before this era. None of these prospective studies attempted to differentiate bacterial and viral pneumonia in adult patients using LUS. The majority of studies considered the LUS examination to be positive if sonographic consolidations or multiple B-lines were observed. Significant differences existed in the accuracy of these studies. Some studies revealed that LUS showed superior sensitivity to chest X-ray. These results indicate that point-of-care LUS has the potential to be an initial imaging modality for the diagnosis of pneumonia. The LUS diagnosis of ventilator-associated pneumonia in intensive care units is more challenging in comparison with the diagnosis of community-acquired pneumonia in emergency departments due to the limited access to the mechanically ventilated patients and the high prevalence of atelectasis. However, several studies have demonstrated that the combination of LUS findings with other clinical markers improved the diagnostic accuracy. In the COVID-19 era, many case reports and small observational studies on COVID-19 pneumonia have been published in a short period. Multiple B-lines were the most common and consistent finding in COVID-19 pneumonia. Serial LUS showed the deterioration of the disease. The knowledge and ideas on the application of LUS in the management of pneumonia that are expected to accumulate in the COVID-19 era may provide us with clues regarding more appropriate management.

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Bedside lung ultrasonography for diagnosis of pneumonia

Cited by 20 publications

References 35 publications

Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

Lung ultrasound for the 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

Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era

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