Diagnostic accuracy, safety and utilisation of respiratory physician-delivered thoracic ultrasound

Abstract

Background Thoracic ultrasound-guided pleural procedures are associated with fewer adverse events than 'blind' procedures for patients with pleural effusion. Ultrasound is increasingly practised by respiratory physicians but there has been no prospective assessment of its safety and diagnostic accuracy when delivered by respiratory physicians. Methods The activity level, safety and diagnostic accuracy of thoracic ultrasound delivered by respiratory physicians were prospectively assessed. Diagnostic accuracy was assessed using a stepwise pragmatic approach (recording if pleural fluid was obtained or effusion was present on another radiological modality). In the absence of the above, ultrasound clips were reviewed by a blinded radiologist. The number of ultrasounds referred to radiologists and adverse events within 1 week were recorded. The complication rate was compared with the published literature. Results 960 ultrasound scans occurred over a 3 year period. The activity of the service increased over time, as a result of increased use of interventional ultrasound. The referral rate to radiology remained constant over the study period (mean proportion 4.0%). Physician-delivered ultrasound correctly identified the presence/absence of pleural fluid in 951 of 955 evaluable scans (99.6% CI 98.9% to 99.9%). The major complication rate was 3/ 558¼0.5% (95% CI 0.1% to 1.6%), which compared favourably with the identified published literature. Conclusion Respiratory physician-delivered thoracic ultrasound appears to be safe and effective in the diagnosis/intervention of pleural effusion, and is associated with a major complication rate comparable with that of published studies. Continued liaison with the radiology service has here been demonstrated as a requirement for a physician-based service.

Pleural infection

“…8,9 Selecting a site for pleural fluid drainage using bedside ultrasonography is safer than the traditional combination of chest x-ray and clinical examination which carries a 10% risk of organ puncture. 10 Thoracentesis-associated complications were reduced from 8% to 1% in one study when a safety programme, including physician-led chest ultrasonography, was introduced.…”

The efficacy of bedside chest ultrasound: from accuracy to outcomes

“…With greater experience, respiratory physicians can be as accurate as radiologists at diagnosing pleural effusion, and have equally low complication rates for ultrasound-guided pleural interventions [49]. There are now validated instruments to assess an individual's skill at using ultrasound to guide pleural effusion drainage [50].…”

Ultrasound Guidance in Detection of Pneumothorax and Thoracentesis Performance:a Review

“…Ultrasound has the ability to show 20 mL of pleural fluid, but upright posteroanterior CXR can reveal at least 100 mL of fluid (Rahman 2010;Turner & Dankoff, 2012) visceral pleural puncture, one of the reasons for pneumothorax is the most considerable complication of thoracentesis (Gordon 2010). The rate of pneumothorax after Thoracentesis is about as 20% to 39% (Grogan, 1990).…”