The Effect of Point-of-Care Ultrasonography on Imaging Studies in the Medical ICU

Oks, Margarita; Cleven, Krystal L.; Cárdenas-García, José; Schaub, Jennifer A.; Koenig, Seth; Cohen, Rubin I.; Mayo, Paul H.; Narasimhan, Mangala

doi:10.1378/chest.14-0728

Cited by 71 publications

(44 citation statements)

References 24 publications

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“…Furthermore, POCLUS has been shown to decrease length of stay in the ED in children with concern for pneumonia . It is also noted that the use of POCLUS is associated with lower financial costs by reducing the use of more invasive and expensive diagnostic tests, shortened ED stay, and less complications associated with invasive procedures (e.g., thoracentesis) …”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

Tsou

Chen

Wang

et al. 2019

Academic Emergency Medicine

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Background: Childhood pneumonia is a leading cause of mortality worldwide. Growing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic alternative to chest x-ray for childhood pneumonia. However, it is unclear whether sonographer experience affects the diagnostic accuracy of LUS. We summarize the diagnostic accuracy of LUS for pneumonia and compare the performance between novice and advanced sonographers with a systematic review and meta-analysis. Methods:We searched PubMed and EMBASE from inception to February 2018 for eligible studies that evaluated the utility of LUS in children suspected of having pneumonia against the reference standard of either imaging results alone or a combination of clinical, laboratory, and imaging results. We reported the study using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies. We used QUADAS-2 to appraise the included studies' methodologic quality. We employed a random-effect bivariate model and a hierarchical summary receiver operating characteristic curve to evaluate LUS's performance characteristics. We conducted subgroup analyses and meta-regression based on level of sonographer training to summarize and compare LUS's diagnostic accuracy for pneumonia between novice (training ≤ 7 days) and advanced sonographers.Results: Twenty-five studies (n = 3,353) were included in the meta-analysis. For diagnosing pneumonia, LUS demonstrated an overall sensitivity of 0.94 (95% confidence interval [CI] = 0.89 to 0.97), specificity of 0.92 (95% CI = 0.78 to 0.98), positive likelihood ratio of 12.40 (95% CI = 4.00 to 38.10), and negative likelihood ratio of 0.07 (95% CI = 0.04 to 0.12), with an area under ROC curve of 0.97 (95% CI = 0.95 to 0.98). Meta-regression revealed a significant difference in the diagnostic accuracy for pneumonia for LUS between novice and advanced sonographers (p < 0.01).Conclusion: LUS can accurately diagnose pneumonia in children. However, this test demonstrates operatordependent variability, with more experienced sonographers having higher diagnostic accuracy. Further work on evidence-based educational methods to train novice sonographers in LUS is required.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

Tsou

Chen

Wang

et al. 2019

Academic Emergency Medicine

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“…Bedside, chest ultrasound by ICU physicians may be a promising alternative. 34,35 Our study is limited by the fact that it was a single-center study and was performed according to an already existing protocol. In addition, we used an observational cohort study design without randomization or blinding.…”

Section: Discussionmentioning

confidence: 99%

Defining indications for selective chest radiography in the first 24 hours after cardiac surgery

Tolsma

Rijpstra

Rosseel

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…Future research should focus on the clinical effectiveness of point‐of‐care pleural ultrasonography when integrated with other diagnostic tools, and application of new ultrasound technologies to evaluate pleural diseases. Routine use of point‐of‐care ultrasound as the primary imaging modality in a medical ICU demonstrated a highly statistically significant reduction in chest x‐rays (3.75 vs 0.82, P < 0.0001) and chest CT scans (0.10 vs 0.04, P = 0.0007) . Similar studies have yet to be performed with the use of ultrasound specifically in the management of pleural diseases.…”

Section: Future Researchmentioning

confidence: 97%

“…Routine use of point-of-care ultrasound as the primary imaging modality in a medical ICU demonstrated a highly statistically significant reduction in chest x-rays (3.75 vs 0.82, P < 0.0001) and chest CT scans (0.10 vs 0.04, P 5 0.0007). 49 Similar studies have yet to be performed with the use of ultrasound specifically in the management of pleural diseases. Thus, clinical effectiveness studies are needed to assess the impact of routine use of pleural ultrasound on the initiation of appropriate therapies, length of stay, and costs in the management of pleural disease.…”

Section: Future Researchmentioning

confidence: 99%

Ultrasound in the diagnosis and management of pleural effusions

Soni

Franco

Velez

et al. 2015

Journal of Hospital Medicine

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174

115

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We review the literature on the use of point-of-care ultrasound to evaluate and manage pleural effusions. Point-of-care ultrasound is more sensitive than physical exam and chest radiography to detect and characterize pleural fluid, and avoids many negative aspects of computerized tomography (CT). Additionally, point-of-care ultrasound can be used to assess pleural fluid volume and character, revealing possible underlying pathologies and guiding management. Thoracentesis performed with ultrasound guidance has lower risk of pneumothorax and bleeding complications. Future research should focus on the clinical-effectiveness of point-of-care ultrasound in the routine management of pleural effusions and how new technologies may expand its clinical utility.

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The Effect of Point-of-Care Ultrasonography on Imaging Studies in the Medical ICU

Cited by 71 publications

References 24 publications

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

Defining indications for selective chest radiography in the first 24 hours after cardiac surgery

Ultrasound in the diagnosis and management of pleural effusions

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