Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

Testa, Americo; Soldati, Gino; Copetti, Roberto; Giannuzzi, Rosangela; Portale, Grazia; Gentiloni-Silveri, Nicolò

doi:10.1186/cc11201

Cited by 133 publications

(158 citation statements)

References 29 publications

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“…Besides, it is noteworthy to highlight the situations that related to false positive and false negative results. The specificity derived from our analysis was lower than previous studies, which was partly caused by the false-positive conditions on LUS: pleural adhesions, bullous emphysema, fluid bronchogram, past interstitial pathology, neoplasia, pulmonary infarction, sepsis of other origins, main-stem intubation on the contralateral side (17,18,20,24). By contrast, the false negative results usually occurred when the consolidation was located far away from pleura and hided deep in the lung parenchyma.…”

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confidence: 48%

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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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confidence: 48%

“…Among all 14 studies, 11 were carried out in emergency department (ED) or medical wards (10,(15)(16)(17)(18)(19)(20)(22)(23)(24)(25), and 3 were conducted in intensive care unit (ICU) (14,21,26). Hemithorax was used as the study unit for result interpretation in one study (23), while others counted by patient.…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

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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“…Previous studies performed both in children and adults have shown that LUS is not inferior to chest radiographs in identifying lung abnormalities in patients with a clinical suspicion of pneumonia [15,16,18,19,[21][22][23][24]. Urbanowska et al [19] showed a high agreement between LUS and chest radiographs, with a Cohen kappa coefficient of agreement of 0.89.…”

Section: Se % (95%ci) Sp % (95%ci) Ppv% (95%ci) Npv % (95%ci) Plr (95mentioning

confidence: 96%

Performance of lung ultrasonography for the diagnosis of communityacquired pneumonia in hospitalized children

et al. 2017

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Aims: The objective of the study was to assess the performance of lung ultrasonography (LUS) as compared to chest radiography and the clinical criteria for the diagnosis of pneumonia in children.Materials and methods: This was a retrospective study in which data were collected from medical files of 81 children admitted with a clinical suspicion of pneumonia in which both an LUS and a chest radiograph during the hospitalization were performed. Reference standard used for the diagnosis of pneumonia were chest radiographs (consolidation, parenchymal infiltrates, and interstitial infiltrate) and clinical criteria. LUSfindings were reported as normal, parenchymal consolidations and pleural effusions. Results: Radiological pneumonia was reported in 72 of the 81 patients (88.9%). LUS identified parenchymal consolidations in 62 cases. LUS correctly identified radiological pneumonia with a sensitivity of 79.2% and a specificity of 44.4%. The positive predictive value (PPV) was 91.9% and the negative predictive value (NPV) was 21.0%. When clinical criteria were used as reference standard, the sensitivity, specificity, PPV and NPV of correctly identifying clinical pneumonia cases by LUS (only consolidations) were 80.0%, 66.7%, 96.8% and 21.0%. When indicative for the presence of pneumonia either the ultrasound consolidation or the ultrasound detected pleural effusion were considered when the sensitivity, PPV and NPV increased to 96.0% (95%CI: 88.8-99.2), 97.3% (95%CI: 92.0-99.1), and 57.1% (95%CI: 27.7-82.2), respectively.Conclusions: In our opinion, our findings together withprevious ones available in the literature recommend LUS as a valuable investigation for the diagnosis of community-acquiredpneumonia in children.

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“…In interstitial pneumonia, an interstitial LUS pattern combined with spared areas is strongly suggestive for viral pneumonia and correlates with the findings on CT scans [40,41]. Nevertheless, some studies lack the ‘gold standard' for diagnosis or have a time lag between LUS and CT [37].…”

Section: Lus Compared With Other Methods In the Diagnosis Of Interstimentioning

confidence: 99%

Lung Ultrasound in Community-Acquired Pneumonia and in Interstitial Lung Diseases

Reißig

Copetti

2014

Respiration

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Lung ultrasound (LUS) is an accurate tool for the diagnosis and follow-up of pneumonia in adults as well as in children. LUS is at least as accurate as chest radiography in diagnosing pneumonia. The most important parenchymal criterion is the positive air bronchogram within an echopoor area. Among pleural criteria, basal effusion was most often detected. The presence of multiple diffuse bilateral B-lines on lung examination indicates the interstitial syndrome (IS). For further differential diagnosis, an integrated consideration of history, clinical examination, LUS and echocardiography should be performed. LUS is an excellent tool for IS screening. Repeated LUS control examinations may reflect the dynamics of IS under therapy and so LUS may serve as a therapy guide.

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Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

Cited by 133 publications

References 29 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

Performance of lung ultrasonography for the diagnosis of communityacquired pneumonia in hospitalized children

Lung Ultrasound in Community-Acquired Pneumonia and in Interstitial Lung Diseases

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