Diagnostic accuracy of sonography for pleural effusion: systematic review

Abstract

CONTEXT AND OBJECTIVE: The initial method for evaluating the presence of pleural effusion was chest radiography. Isolated studies have shown that sonography has greater accuracy than radiography for this diagnosis; however, no systematic reviews on this matter are available in the literature. Thus, the aim of this study was to evaluate the accuracy of sonography in detecting pleural effusion, by means of a systematic review of the literature. DESIGN AND SETTING:This was a systematic review with meta-analysis on accuracy studies. This study was conducted in the Department of Diagnostic METHOD:The following databases were searched: Cochrane Library, Medline, Web of Science, Embase and Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). The references of relevant studies were also screened for additional citations of interest. Studies in which the accuracy of sonography for detecting pleural effusion was tested, with an acceptable reference standard (computed tomography or thoracic drainage), were included.RESULTS: Four studies were included. All of them showed that sonography had high sensitivity, specificity and accuracy for detecting pleural effusions. The mean sensitivity was 93% (95% confidence interval, CI: 89% to 96%), and specificity was 96% (95% CI: 95% to 98%). CONCLUSIONS:In different populations and clinical settings, sonography showed consistently high sensitivity, specificity and accuracy for detecting fluid in the pleural space.RESUMO CONTEXTO E OBJETIVOS: O método inicial para a avaliação da presença dos derrames pleurais foi a radiografia de tórax. Estudos isolados demonstraram que a ultrassonografia apresenta uma acurácia maior que a radiografia para este diagnóstico, entretanto, não se encontram disponíveis na literatura revisões sistemáticas sobre este tema. Assim, o objetivo deste estudo é avaliar a acurácia da ultrassonografia na detecção de derrame pleural, por meio de revisão sistemática da literatura. Caribe em Ciências da Saúde (Lilacs). As referências de estudos relevantes foram verificadas para adicionais citações de interesse. Foram incluídos estudos nos quais a acurácia da ultrassonografia para a detecção de derrame pleural tenha sido testada, com padrão referência aceitável (tomografia computadorizada ou drenagem torácica). TIPO DE ESTUDO E LOCAL: RESULTADOS:Foram incluídos quatro estudos. Todos apresentaram alta sensibilidade, especificidade e acurácia para a detecção de derrame pleural pela ultrassonografia. A sensibilidade média foi de 93% (intervalo de confiança, IC 95%: 89% a 96%), e a especificidade 96% (IC 95%: 95% a 98%). CONCLUSÕES:A ultrassonografia, em diferentes populações e cenários clínicos, apresentou consistentemente alta sensibilidade, especificidade e acurácia na detecção de líquido no espaço pleural.

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