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...
Background Evidence from previous studies comparing lung ultrasound to thoracic computed tomography (CT) in intensive care unit (ICU) patients is limited due to multiple methodologic weaknesses. While addressing methodologic weaknesses of previous studies, the primary aim of this study is to investigate the diagnostic accuracy of lung ultrasound in a tertiary ICU population. Methods This is a single-center, prospective diagnostic accuracy study conducted at a tertiary ICU in the Netherlands. Critically ill patients undergoing thoracic CT for any clinical indication were included. Patients were excluded if time between the index and reference test was over eight hours. Index test and reference test consisted of 6-zone lung ultrasound and thoracic CT, respectively. Hemithoraces were classified by the index and reference test as follows: consolidation, interstitial syndrome, pneumothorax and pleural effusion. Sensitivity, specificity, positive and negative likelihood ratio were estimated. Results In total, 87 patients were included of which eight exceeded the time limit and were subsequently excluded. In total, there were 147 respiratory conditions in 79 patients. The estimated sensitivity and specificity to detect consolidation were 0.76 (95%CI: 0.68 to 0.82) and 0.92 (0.87 to 0.96), respectively. For interstitial syndrome they were 0.60 (95%CI: 0.48 to 0.71) and 0.69 (95%CI: 0.58 to 0.79). For pneumothorax they were 0.59 (95%CI: 0.33 to 0.82) and 0.97 (95%CI: 0.93 to 0.99). For pleural effusion they were 0.85 (95%CI: 0.77 to 0.91) and 0.77 (95%CI: 0.62 to 0.88). Conclusions In conclusion, lung ultrasound is an adequate diagnostic modality in a tertiary ICU population to detect consolidations, interstitial syndrome, pneumothorax and pleural effusion. Moreover, one should be careful not to interpret lung ultrasound results in deterministic fashion as multiple respiratory conditions can be present in one patient. Trial registration This study was retrospectively registered at Netherlands Trial Register on March 17, 2021, with registration number NL9344.
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