Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

Chavez, Miguel A.; Shams, Navid; Ellington, Laura E.; Naithani, Neha; Gilman, Robert H.; Steinhoff, Mark C.; Santosham, Mathuram; Black, Robert E.; Price, Carrie; Gross, Margaret; Checkley, William

doi:10.1186/1465-9921-15-50

Cited by 345 publications

(317 citation statements)

References 35 publications

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“…The results of the trails conducted in Europe were similar to the data in China, suggesting the diagnosis accuracy is solid and might not be affected by race and region, only if the physicians were well-trained. Once again, our results confirmed LUS was a more powerful tool of rapid pneumonia detection than CXR.To date, three meta-analyses have summarized the data concerning LUS and pneumonia (4,11,34). In the analysis by Hu and colleagues (34), they studied the patients with pneumonia of all ages.…”

supporting

confidence: 76%

“…To date, three meta-analyses have summarized the data concerning LUS and pneumonia (4,11,34). In the analysis by Hu and colleagues (34), they studied the patients with pneumonia of all ages.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging evaluation approaches recommended on current guidelines are chest radiograph and chest computerized tomography (CT) (2,3). However, limitations for their use exist (4). Surprisingly, a recent study compared CXR to chest CT scan for suspected CAP.…”

Section: Original Articlementioning

confidence: 99%

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Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Yang¹,

Ying²,

Wang³

et al. 2016

J. Thorac. Dis.

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Background: Pneumonia is usually presented as a forgotten killer, and an early diagnosis could largely improve the prognostic outcomes. Lung ultrasound (LUS) has been universally applied in evaluating multiple pulmonary diseases including pneumonia. However, the diagnosis accuracy of LUS for pneumonia in adults is still uncertain. Hence, we performed a systematic review of the current literature to assess the diagnosis accuracy of LUS for pneumonia in adults.Methods: PubMed and EMBASE were searched for clinical trials that assessed the detection accuracy of LUS for pneumonia in adult patients. We extracted descriptive and quantitative information from eligible studies that met strict inclusion criteria and calculated pooled sensitivity, specificity and pooled diagnostic likelihood ratios (LR). Summary receiver operating characteristic (sROC) curve was used to assess the overall performance of LUS-based assays.Results: We reviewed 1,072 articles and selected 38 for detailed review. 14 articles containing 1,911 participants met all inclusion criteria and were included in the final analysis. LUS exhibited a pooled sensitivity of 0.904 (0.884-0.921), specificity of 0.884 (0.861-0.904), positive LR of 6.6 (3.7-11.7), negative LR of 0.08 (0. 04-0.19) and the area under curve (AUC) was 0.9611. Interestingly, when CT alone, CT combined with clinical presentations, and microbiology was set as the gold standard of pneumonia respectively, LUS demonstrated a pooled sensitivity of 90.9%, 95.0%, 53.3%, and a pooled specificity of 89.7%, 91.3% and 67.9%. In extension, we compared the diagnostic efficiency of LUS for pneumonia with chest X-ray (CXR) in 1,343 patients. The AUC for LUS and CXR was 0.972 and 0.867 respectively and the Z statistic of the two sROC curves was 2.31.Conclusions: Our study indicated that LUS is a robust diagnostic tool for pneumonia with high accuracy.Utilization of LUS would facilitate the estimation of pneumonia at bedside. be based on swift and accurate recognition. The signs and symptoms localizing to the respiratory system, commonly referring as dyspnea, cough and fever, laboratory alterations (leukocytosis and increased c-reactive protein/procalcitonin) in conjunction with radiographic pulmonary infiltrate, point to convincing diagnosis of pneumonia. Imaging evaluation approaches recommended on current guidelines are chest radiograph and chest computerized tomography (CT) (2,3). However, limitations for their use exist (4). Surprisingly, a recent study compared CXR to chest CT scan for suspected CAP. They found up to 30% false positive and false negative rate of CXR in emergency department (ED), which doubted the value of CXR on pneumonia diagnosis (5). Thus, it's reasonable to figure out the alternative way to provide promising imaging evidence of pneumonia.Ultrasonography is gaining more attention in critical care and emergency medicine. A good body of studies has proven that ultrasonography is highly effective in evaluating multiple pulmonary diseases, such as metastatic lymph node of lung c...

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supporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Yang¹,

Ying²,

Wang³

et al. 2016

J. Thorac. Dis.

View full text Add to dashboard Cite

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“…Furthermore, increasing evidence supports superior diagnostic performance of lung ultrasound over chest radiography, such as when evaluating a pleural effusion (15), ruling out a pneumothorax in trauma (4), differentiating volume overload from an exacerbation of obstructive lung disease (16), or diagnosing pneumonia (17). The list of diseases that can be readily evaluated with lung ultrasound continues to expand, and now includes interstitial lung diseases (18), postoperative atelectasis (19), and diffuse alveolar hemorrhage (20).…”

Section: Commentarymentioning

confidence: 99%

Lung ultrasound in acute respiratory distress syndrome and beyond

Baston¹,

West²

2016

J. Thorac. Dis.

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“…In a recent systematic review comparing ultrasound with chest CT, lung ultrasound in adults was found to have a sensitivity of 94% and a specificity of 96% for pneumonia. 3 For patients arriving with undifferentiated shortness of breath and sepsis, PoCUS may be a valuable tool to help to rapidly diagnose the presence of important lung and pleural pathology.…”

Section: Introductionmentioning

confidence: 99%

Simple Pneumonia or Something More?: A Case Report and Discussion of Unexpected Empyema Identified by Point-of-Care Ultrasound

Romano

Jelic

Chenkin

2015

CJEM

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There is evidence to suggest that point-of-care ultrasound assessment of the lungs has a higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia. It is unknown if the same is true for pneumonia complications. We present and discuss the case of a 61-yearold woman who presented to the emergency department with confusion, decreased level of consciousness, and signs of sepsis. A chest x-ray revealed a right sided infiltrate. An ultrasound of the patient's lungs was performed, and revealed a complex loculated fluid collection consistent with an empyema. A chest CT confirmed the diagnosis, and immediate percutaneous drainage was performed. RÉSUMÉCertaines données autorisent à penser que l'échographie pratiquée au point de service aurait une sensibilité et une spécificité plus grandes que la radiographie des poumons dans le diagnostic de la pneumonie. Toutefois, l'on ne sait pas si la même observation vaut pour les complications de la pneumonie. Sera exposé ici le cas d'une femme de 61 ans, examinée au service des urgences pour de la confusion, une diminution de l'état de conscience et des signes de sepsie; suivra une discussion. Une radiographie des poumons a révélé la présence d'infiltration dans les tissus du côté droit. De son côté, l'échographie a montré une image d'une collection liquidienne loculée complexe, compatible avec celle d'un empyème. Une tomodensitométrie des poumons a permis de confirmer le diagnostic, et on a aussitôt procédé au drainage percutané.

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Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

Cited by 345 publications

References 35 publications

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Lung ultrasound in acute respiratory distress syndrome and beyond

Simple Pneumonia or Something More?: A Case Report and Discussion of Unexpected Empyema Identified by Point-of-Care Ultrasound

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