Diagnostic Accuracy of Chest Radiograph, and When Concomitantly Studied Lung Ultrasound, in Critically Ill Patients With Respiratory Symptoms: A Systematic Review and Meta-Analysis

Winkler, Michiel H; Touw, H.R.W.; Ven, Peter M. van de; Twisk, Jos W. R.; Tuinman, Pieter R.

doi:10.1097/ccm.0000000000003129

Cited by 117 publications

(114 citation statements)

References 27 publications

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“…As stated by Hirschtick, a "quick physical exam" is often used by the unexperienced fingers and is not much worth 47 . Lastly, a diagnostic tool can be considered obsolete when a more accurate diagnostic test is available, for example lung ultrasound which is further described below 48 .…”

Section: Discussionmentioning

confidence: 99%

“…LUS, which should be seen as part of the physical examination, has many potential advantages over lung auscultation and CXR: its high accuracy, quick and easy performance and interpretation at the bedside; dynamic imaging; avoidance of radiation and contrast burden; evaluation of disease progress; and reduction of costs 51 . LUS turned out to be highly accurate for most diagnosis studied in this meta-analysis with a sensitivity and specificity of more than 90% 48,[51][52][53][54][55][56] . There is also evidence showing that LUS detects respiratory problems at an early stage and impacts clinical decision making 54,[57][58][59][60][61] .…”

Section: Further Implicationsmentioning

confidence: 99%

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The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

Arts

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Ven

et al. 2020

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The stethoscope is used as first line diagnostic tool in assessment of patients with pulmonary symptoms. However, there is much debate about the diagnostic accuracy of this instrument. This metaanalysis aims to evaluate the diagnostic accuracy of lung auscultation for the most common respiratory pathologies. Studies concerning adult patients with respiratory symptoms are included. Main outcomes are pooled estimates of sensitivity and specificity with 95% confidence intervals, likelihood ratios (LRs), area under the curve (AUC) of lung auscultation for different pulmonary pathologies and breath sounds. A meta-regression analysis is performed to reduce observed heterogeneity. For 34 studies the overall pooled sensitivity for lung auscultation is 37% and specificity 89%. LRs and AUC of auscultation for congestive heart failure, pneumonia and obstructive lung diseases are low, LR− and specificity are acceptable. Abnormal breath sounds are highly specific for (hemato)pneumothorax in patients with trauma. Results are limited by significant heterogeneity. Lung auscultation has a low sensitivity in different clinical settings and patient populations, thereby hampering its clinical utility. When better diagnostic modalities are available, they should replace lung auscultation. Only in resource limited settings, with a high prevalence of disease and in experienced hands, lung auscultation has still a role.Diagnostic summary measures. The overall pooled sensitivity for lung auscultation is 37% (95% CI: 30-47%) and specificity 89% (95% CI: 85-92%) (see Table 2 and Fig. 2). Table 3 shows the pooled estimates of sensitivity and specificity for the different types of breath sounds: abnormal, decreased or absent breath sounds, crackles, rhonchi, and wheezes. Heterogeneity was significant when considering all outcomes (P < 0.001), but also when restricted to CHF, OLD and pneumonia. Only heterogeneity of study outcomes for HPT was not significant (P = 0.38). Deeks' Funnel Plot for all studies (Fig. 3) suggests publication bias (P = 0.01) when considering all outcomes. Publication bias was not significant, when restricting to CHF (P = 0.18), HPT (P = 0.34), OLD (P = 0.75) and pneumonia (P = 0.99). It must, however, be noted that the estimates of the bias when restricting to CHF and HPT were larger than the estimate of the bias based on all outcomes. Therefore, lack of significance for these pathology groups may be due to the small sample sizes (n = 10 and n = 6, respectively). Estimates of bias in the OLD and pneumonia subgroups were much smaller than the estimate of the bias based on all outcomes and sample sizes were larger compared to other subgroups (n = 22 and n = 29, respectively), suggesting the absence of publication bias for those pathology groups (see e- Fig. 1A-D).Congestive heart failure. Six prospective observational studies included patients with (acute) dyspnoea and compared auscultation with Doppler echocardiography, the Framingham criteria or by an expert panel for CHF [12][13][14][15][16][17] . Considering the res...

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Section: Discussionmentioning

confidence: 99%

Section: Further Implicationsmentioning

confidence: 99%

The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

Arts

Lim

Ven

et al. 2020

Sci Rep

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“…Respiratory muscle weakness as the major cause for acute respiratory failure is uncommon, but should be considered if more common causes have been excluded [30,31]. The clinical presentation of diaphragm dysfunction depends on the cause, severity and rate of progression (E-Table 1) [32].…”

Section: Role Of Respiratory Muscle Ultrasound In Acute Respiratory Fmentioning

confidence: 99%

Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients—a narrative review

et al. 2020

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Respiratory muscle ultrasound is used to evaluate the anatomy and function of the respiratory muscle pump. It is a safe, repeatable, accurate, and non-invasive bedside technique that can be successfully applied in different settings, including general intensive care and the emergency department. Mastery of this technique allows the intensivist to rapidly diagnose and assess respiratory muscle dysfunction in critically ill patients and in patients with unexplained dyspnea. Furthermore, it can be used to assess patient-ventilator interaction and weaning failure in critically ill patients. This paper provides an overview of the basic and advanced principles underlying respiratory muscle ultrasound with an emphasis on the diaphragm. We review different ultrasound techniques useful for monitoring of the respiratory muscle pump and possible therapeutic consequences. Ideally, respiratory muscle ultrasound is used in conjunction with other components of critical care ultrasound to obtain a comprehensive evaluation of the critically ill patient. We propose the ABCDE-ultrasound approach, a systematic ultrasound evaluation of the heart, lungs and respiratory muscle pump, in patients with weaning failure.

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“…Over the last 10 years, several papers have confirmed the usefulness of LUS in specific settings . In particular, the accuracy of LUS is at least not inferior to CXR in the diagnosis and monitoring of pneumothorax (PTX), pleural effusion, interstitial syndrome (IS) and community‐acquired pneumonia (CAP) . Furthermore, LUS detects some signs of cardiac involvement in the context of some diseases such as acute pulmonary oedema or heart failure …”

Section: Introductionmentioning

confidence: 98%

Relevance of lung ultrasound in the diagnostic algorithm of respiratory diseases in a real‐life setting: A multicentre prospective study

et al. 2019

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Background and objective: The aim of this study was to assess the role of lung ultrasound (LUS) in a diagnostic algorithm of respiratory diseases, and to establish the accuracy of LUS compared with chest radiography (CXR). Methods: Over a period of 2 years, 509 consecutive patients admitted for respiratory-related symptoms to both emergency and general medicine wards were enrolled and evaluated using LUS and CXR. LUS was conducted by expert operators who were blinded to the medical history and laboratory data. Computed tomography (CT) of the chest was performed in case of discordance between the CXR and LUS, suspected lung cancer and an inconclusive diagnosis. Diagnosis made by CT was considered the gold standard. Results: The difference in sensitivity and specificity between LUS and CXR as demonstrated by ROC curve analyses (LUS-AUROC: 0.853; specificity: 81.6%; sensitivity: 93.9% vs CXR-AUROC: 0.763; specificity: 57.4%; sensitivity: 96.3%) was significant (P = 0.001). Final diagnosis included 240 cases (47.2%) of pneumonia, 44 patients with cancer (8.6%), 20 patients with chronic obstructive pulmonary disease (COPD, 3.9%), 24 patients with heart failure (4.7%) and others (6.1%). In 108 patients (21.2%) with any lung pathology, a CT scan was performed with a positive diagnosis in 96 cases (88.9%); we found that CXR and LUS detected no abnormality in 24 (25%) and 5 (5.2%) cases, respectively. LUS was concordant with the final diagnosis (P < 0.0001), and in healthy patients, there was a low percentage of false positives (5.9%). Conclusion:The results support the routine use of LUS in the clinical context. SUMMARY AT A GLANCELung ultrasound (LUS) provided a useful diagnostic workup of respiratory disease, either by directly identifying pathological findings or by detecting indirect signs of illness, as in lung cancer. Overall, LUS was not inferior to chest radiography and routine use in medical wards or in emergency department settings is beneficial. Respirology (2020) 25, 535-542 536 L Rinaldi et al. † EPA, pleural effusion, tuberculosis, fibrosis/restrictive syndrome and PTX. COPD, chronic obstructive pulmonary disease; EPA, acute pulmonary embolism; LUS, lung ultrasound; PTX, pneumothorax.Respirology (2020) 25, 535-542

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Diagnostic Accuracy of Chest Radiograph, and When Concomitantly Studied Lung Ultrasound, in Critically Ill Patients With Respiratory Symptoms: A Systematic Review and Meta-Analysis

Cited by 117 publications

References 27 publications

The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients—a narrative review

Relevance of lung ultrasound in the diagnostic algorithm of respiratory diseases in a real‐life setting: A multicentre prospective study

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