Pneumonia Lung Ultrasound Score (PLUS): A New Tool for Detecting Pneumonia in the Oldest Patients

Abstract

OBJECTIVES To compare the diagnostic accuracy of lung ultrasound (LUS) and standard chest X‐ray (CXR) in older patients admitted to an acute‐care geriatric ward for suspected acute pneumonia, and to develop an easy‐to‐use diagnostic tool, now called Pneumonia Lung Ultrasound Score (PLUS), for early risk stratification. DESIGN Prospective, single‐center, cohort study. SETTING Acute‐care geriatric ward of tertiary care center. PARTICIPANTS Individuals, aged 65 years and older, with suspected acute pneumonia. MEASUREMENTS Participants were stratified according to the Multidimensional Prognostic Index. All the patients underwent CXR and LUS, whereas chest computed tomography was performed in case of mismatch between LUS and CXR. Using logistic multivariate regression, we assessed the influence of age, sex, multimorbidity, cognitive impairment, and clinical biomarkers in the misdiagnosis of acute pneumonia. Finally, an easy‐to‐perform diagnostic tool based on the combination of biomarkers (brain natriuretic peptide, high‐sensitivity C‐reactive protein, and partial pressure arterial oxygen/fraction of inspired oxygen ratio) and LUS was realized. A receiver operating characteristic curve was used to verify the predictive accuracy of PLUS, CXR, and LUS in pneumonia diagnosis. RESULTS A total of 132 subjects (69% women; mean age = 85.3 ± 6.9 years) were enrolled in the study. Acute pneumonia was diagnosed in 94 of 132 cases. LUS showed higher diagnostic accuracy compared with CXR (0.91 (95% confidence interval (CI) = 0.85–0.93) vs 0.67 (95% CI = 0.58–0.75)) in detecting pneumonic consolidations. A higher degree of cognitive impairment was associated with both LUS and CXR pneumonia misdiagnosis (odds ratio = 1.30 (95% CI = 1.04–1.65)). PLUS showed higher predictive accuracy in the diagnosis of acute pneumonia compared with LUS (AUC = 0.92 (95% CI = 0.87–0.98) vs 0.86 (95% CI = 0.80–0.96); P = .029). CONCLUSIONS This study confirms the higher diagnostic accuracy of LUS compared with CXR for acute pneumonia in older adults. Nonetheless, the accuracy of PLUS, an easy‐to‐use, biomarker‐derived diagnostic tool, was superior to LUS regardless of patientsʼ degree of frailty.

Is non-thyroidal illness syndrome (NTIS) a clinical predictor of COVID-19 mortality in critically ill oldest old patients?

“…In the present observational, single-center study we performed a post-hoc analysis of a cohort of older patients hospitalized for non-COVID-19 pneumonia admitted to our Geriatrics Unit from July 2018 to January 2019 [ 7 ], and data collected from a cohort of older patients consecutively hospitalized for COVID-19 pneumonia from April to March 2020. In both the cohorts, demographic characteristics and clinical history were obtained at admission; Charlson comorbidity index [ 8 ] was reported to evaluate the patients’ burden of comorbidities.…”

Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia

“…In both studies, the accuracy of LUS combined with PCT was comparable to that obtained in our study combining LUS and C-reactive protein. A recent study performed in an acute Geriatrics Unit demonstrated that adding clinical and biochemical variables (including C-reactive protein) to LUS improved diagnostic accuracy, leading to a more accurate diagnosis of pneumonia in old patients with acute respiratory failure [ 31 ]. Thus, our findings suggests that LUS is a useful tool for the diagnosis of acute pneumonia in CCU and is accuracy improved combining information from serum C reactive protein mainly reducing the number of false positive results and increasing the specificity of the test.…”

Imaging techniques in Veterinary Medicine. Part I: Radiography and Ultrasonography

“…Thoracic Ultrasonography also called Pleural and Lung Ultrasonography (PLUS) [ 46 ] is a useful tool to detect causes undelying to dyspnea, especially when standard thoracic radiographic images are uncertain [ 46 ].…”