Accuracy of Point-of-Care Multiorgan Ultrasonography for the Diagnosis of Pulmonary Embolism

Nazerian, Peiman; Vanni, Simone; Volpicelli, Giovanni; Gigli, Chiara; Zanobetti, Maurizio; Bartolucci, Maurizio; Ciavattone, Antonio; Lamorte, Alessandro; Veltri, Andrea; Fabbri, Andrea; Grifoni, Stefano

doi:10.1378/chest.13-1087

Cited by 201 publications

(88 citation statements)

References 38 publications

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“…Thirteen studies were eligible for this meta-analysis [10, 17–19, 25–33]. The flow chart and according exclusion reasons were summarized in Fig 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The HSROC was 0.95 (95% CI, 0.92 to 0.96). There were 8 studies published post-2000 [10, 25–30, 33], and the pooled sensitivity, specificity, PLR, NLR and DOR were 0.77 (95% CI, 0.70 to 0.83), 0.88 (95% CI, 0.78 to 0.94), 6.31 (95% CI, 3.56 to 11.19), 0.26 (95% CI, 0.21 to 0.34) and 23.89 (95% CI, 13.44 to 42.46). The HSROC was 0.86 (95% CI, 0.83 to 0.89).…”

Section: Resultsmentioning

confidence: 99%

“…In recent years, CTPA has replaced PA as a first-line method for the diagnosis of PE, because of its easy availability, high accuracy and ability of differential diagnosis [6, 9]. However, only 13%-33% of patients with suspected acute PE are tested positive for acute PE on CTPA [10, 11]. Meanwhile, the use of CTPA results in significant exposure to ionizing radiation, as well as a risk of contrast nephropathy.…”

Section: Introductionmentioning

confidence: 99%

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Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis

Jiang

Zhao

et al. 2015

PLoS ONE

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BackgroundPulmonary embolism (PE) is a potentially life-threatening condition. Although computed tomography pulmonary angiography (CTPA) is the reference standard for diagnosis, its early diagnosis remains a challenge, and the concerns about the radiation exposures further limit the general use of CTPA. The primary aim of this meta-analysis was to evaluate the overall diagnostic accuracy of transthoracic lung ultrasound (TLS) in the diagnosis of PE.MethodsPubMed, Web of science, OvidSP, ProQuest, EBSCO, Cochrane Library and Clinicaltrial.gov were searched systematically. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and hierarchical summary receiver operating characteristic (HSROC) curves were used to examine the TS performance. The Bayes analysis was used to calculate the post-test probability of PE. Publication bias was assessed with Deeks funnel plot.ResultsThe results indicated that the sensitivity, specificity, PLR and NLR were 0.85 (95% confidence interval (CI), 0.78 to 0.90), and 0.83 (95% CI, 0.73 to 0.90). And the DOR and HSROC were 28.82 (95% CI, 17.60 to 47.21), 0.91(95% CI, 0.88, 0.93).ConclusionsThe present meta-analysis suggested that transthoracic lung ultrasonography is helpful in diagnosing pulmonary embolism. Although the application of transthoracic lung ultrasound may change some patients’ diagnostic processes, it is inappropriate to generally use transthoracic ultrasonography in diagnosing pulmonary embolism currently.

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“…Thirteen studies were eligible for this meta-analysis [10, 17–19, 25–33]. The flow chart and according exclusion reasons were summarized in Fig 1 .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis

Jiang

Zhao

et al. 2015

PLoS ONE

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“…In this context, a recent trial by Nazerianet al [32 ]investigated the diagnostic validity of three-organ ultrasonography (chest, heart and leg veins) combined with the Wells score and D-dimer value. They demonstrated nicely that this combined approach was more sensitive than single-organ ultrasound and increased the accuracy of clinical pretest probability estimation in patients with suspected PE and reduced the indication for diagnostic pulmonary CT angiography.…”

Section: Sonography and Sonomorphology Of Important Thoracic Emergenciesmentioning

confidence: 99%

Emergency Ultrasound of the Chest

Kreuter

Mathis

2014

Respiration

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Thoracic ultrasound is a noninvasive and portable diagnostic tool which is highly indicated for an initial workup of thoracic emergencies. The suspicion of a pneumothorax, pneumonia, pulmonary embolism or a lung contusion after trauma can be quickly assessed using ultrasound. Main advantages are its good availability and the steep learning curve. Another advantage of thoracic sonography is that this rapid, symptom-based examination has a high sensitivity and specificity. However, a disadvantage is that only pleura-affecting lesions or lesions visible through a sound window, e.g. an effusion or a subpleural consolidation, can be reached.

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“…However, these additional signs are more laborious and need an advanced skill to be evaluated. Moreover, they are not sufficiently sensitive and specific when considered alone [15–17]. Finally, in cases of dilated RV, adjunctive signs of chronic dilation should be considered, like the thickness of the RV wall (superior to 5 mm), LV status, regional impairments, together with clinical history when available.…”

Section: Introductionmentioning

confidence: 99%

Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians

2016

Self Cite

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BackgroundPoint-of-care ultrasonography (POCUS) is a widely used tool in emergency and critical care settings, useful in the decision-making process as well as in interventional guidance. While having an impressive diagnostic accuracy in the hands of highly skilled operators, inexperienced practitioners must be aware of some common misinterpretations that may lead to wrong decisions at the bedside.ObjectivesThis article provides a revision list of common POCUS misdiagnoses usually found in practice and offers useful tips to recognize and avoid them.DiscussionThe following aspects were selected and reviewed: pericardial effusion vs. pleural vs. ascites vs. epicardial fat; right ventricle dilation in acute pulmonary embolism and inferior vena cava for volume status assessment in cardiac ultrasound; lung point and lung pulse misinterpretations and mirror artifacts vs. lung consolidations in lung ultrasound; peritoneal fluid vs. the stomach and a critical appraisal of gallbladder signs of acute cholecystitis in abdominal ultrasound; the rouleaux phenomenon vs. deep vein thrombosis or acute right strain in vascular ultrasound.ConclusionsFollowing some rules in technique and interpretation, and always integrating POCUS findings into the broader clinical context, most POCUS misdiagnosis can be avoided, and thus patients’ safety can be enhanced. Being aware of a list of common pitfalls may help to avoid misdiagnoses.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-016-0052-x) contains supplementary material, which is available to authorized users.

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Accuracy of Point-of-Care Multiorgan Ultrasonography for the Diagnosis of Pulmonary Embolism

Cited by 201 publications

References 38 publications

Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis

Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis

Emergency Ultrasound of the Chest

Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians

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