Validity of Lung Ultrasound: Is an Image Worth More Than a Thousand Sounds?

Abstract

Introduction: There is debate as to whether lung-ultrasound (LUS) can replace lung-auscultation (LA) in the assessment of respiratory diseases. Methodology: The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. Standard formulas were used to calculate the diagnostic sensitivity, specificity, and accuracy. The interobserver agreement with respect to the LA and LUS findings was evaluated based on the Kappa coefficient (ᴋ). Results: A total of 115 patients were studied. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs. 77.02%; p = 0.001) and more specifically in the case of decompensated obstructive airway diseases (95.6% vs. 19.10%; p = 0.001). The diagnostic accuracy of LUS was also greater in the case of pulmonary infections (75.65% vs. 60.90%; p = 0.02). The sensitivity and specificity of the combination of LA and LUS was 95.95%, 50% in pulmonary infections, 76.19%, 100% in case of decompensated obstructive airway diseases, and (100%, 88.54%) in case of interstitial diseases. (ᴋ) was 0.71 for an A-pattern, 0.73 for pathological B‑lines, 0.94 for condensations, 0.89 for pleural-effusion, 0.63 for wheezes, 0.38 for rhonchi, 0.68 for fine crackles, 0.18 for coarse crackles, and 0.29 for a normal LA. Conclusions: There is a greater interobserver agreement in the interpretation of LUS-findings compared to that of LA-noises, their combined use improves diagnostic performance in all diseases examined.

Validity of a deep learning algorithm for detecting wheezes and crackles from lung sound recordings in adults

“…Three pediatric pulmonologists identified wheezes with a kappa of 0.76 in 55 good-quality recordings from six patients 27 . In a clinical study of 115 hospitalized patients, similar kappa-agreements as in our study was found for wheezes and fine crackles, but lower values for rhonchi and coarse crackles 28 .…”

Interest of Lung Ultrasound in the Management of Acute Heart Failure in Post-emergency Service

“…For Panuccio et al [17], in patients with AKI, the agreement between lung crackles and LUS-B lines was poor (κ = 0.02, p = 0.63). Ramos-Hernandez et al [20] compared the interobserver agreement of LUS and lung auscultation, finding good reproducibility for B-lines (κ = 0.81 [CI 95% : 0.81 -0.83]) but poor repoducibility for crackles (κ = 0.18 [CI 95% : 0.16 -0.20]).…”