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      The diagnostic accuracy of chest ultrasound for CT-detected radiographic consolidation in hospitalised adults with acute respiratory failure: a systematic review

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          Abstract

          Objectives

          (1) Summarise chest ultrasound accuracy to diagnose radiological consolidation, referenced to chest CT in patients with acute respiratory failure (ARF). (2) Directly compared ultrasound with chest X-ray.

          Setting

          Hospitalised patients.

          Participants

          Studies were eligible if adult participants in respiratory failure underwent chest ultrasound to diagnose consolidation referenced to CT. Exclusion: (1) not primary study, (2) not respiratory failure, (3) not chest ultrasound, (4) not consolidation, (5) translation unobtainable, (6) unable to extract data, (7) unable to obtain paper. 4 studies comprising 224 participants met inclusion.

          Outcome measures

          As planned, paired forest plots display 95% CIs of sensitivity and specificity for ultrasound and chest X-ray. Sensitivity and specificity from each study are plotted in receiver operator characteristics space. Meta-analysis was planned if studies were sufficiently homogeneous and numerous (≥4). Although this numerical requirement was met, meta-analysis was prevented by heterogeneous units of analysis between studies.

          Results

          All studies were in intensive care, with either a high risk of selection bias or high applicability concerns. Studies had unclear or high risk of bias related to use of ultrasound. Only 1 study clearly performed ultrasound within 24 h of respiratory failure diagnosis. Ultrasound sensitivity ranged from 0.91 (95% CI 0.81 to 0.97) to 1.00 (95% CI 0.95 to 1.00). Specificity ranged from 0.78 (95% CI 0.52 to 0.94) to 1.00 (0.99 to 1.00). In two studies, chest X-ray had lower sensitivity than ultrasound, but there were insufficient patients to compare specificity.

          Conclusions

          Four small studies suggest ultrasound is highly sensitive and specific for consolidation in ARF, but high risk of bias and concerns about applicability in all studies may have inflated diagnostic accuracy. Further robustly designed studies are needed to define the role of ultrasound in this setting.

          Trial registration number

          http://www.crd.york.ac.uk/PROSPERO/ (CRD42013006472).

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          Most cited references16

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          BTS guidelines for the management of community acquired pneumonia in adults: update 2009.

          W Lim, S Baudouin, R C George … (2009)
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            Lung ultrasound in critically ill patients: comparison with bedside chest radiography.

            Eumorfia Kondili, Alexandros Patrianakos, N Xirouchaki … (2011)
            To compare the diagnostic performance of lung ultrasound and bedside chest radiography (CXR) for the detection of various pathologic abnormalities in unselected critically ill patients, using thoracic computed tomography (CT) as a gold standard. Forty-two mechanically ventilated patients scheduled for CT were prospectively studied with a modified lung ultrasound protocol. Four pathologic entities were evaluated: consolidation, interstitial syndrome, pneumothorax, and pleural effusion. Each hemithorax was evaluated for the presence or absence of each abnormality. Eighty-four hemithoraces were evaluated by the three imaging techniques. The sensitivity, specificity, and diagnostic accuracy of CXR were 38, 89, and 49% for consolidation, 46, 80, and 58% for interstitial syndrome, 0, 99, and 89% for pneumothorax, and 65, 81, and 69% for pleural effusion, respectively. The corresponding values for lung ultrasound were 100, 78, and 95% for consolidation, 94, 93, and 94% for interstitial syndrome, 75, 93, and 92% for pneumothorax, and 100, 100, and 100% for pleural effusion, respectively. The relatively low sensitivity of lung ultrasound for pneumothorax could be due to small number of cases (n = 8) and/or suboptimal methodology. In our unselected general ICU population lung ultrasound has a considerably better diagnostic performance than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to thoracic CT.
            Article 0 comments Cited 126 times – based on 0 reviews     Review now
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              Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

              Miguel Mayoral-Chávez, Navid Shams, Laura E Ellington … (2014)
              Background Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pneumonia. We conducted a meta-analysis to summarize existing evidence of the diagnostic accuracy of LUS for pneumonia in adults. Methods We conducted a systematic search of published studies comparing the diagnostic accuracy of LUS against a referent CXR or chest CT scan and/or clinical criteria for pneumonia in adults aged ≥18 years. Eligible studies were required to have a CXR and/or chest CT scan at the time of evaluation. We manually extracted descriptive and quantitative information from eligible studies, and calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled positive and negative likelihood ratios (LR) using the DerSimonian-Laird method. We assessed for heterogeneity using the Q and I2 statistics. Results Our initial search strategy yielded 2726 articles, of which 45 (1.7%) were manually selected for review and 10 (0.4%) were eligible for analyses. These 10 studies provided a combined sample size of 1172 participants. Six studies enrolled adult patients who were either hospitalized or admitted to Emergency Departments with suspicion of pneumonia and 4 studies enrolled critically-ill adult patients. LUS was performed by highly-skilled sonographers in seven studies, by trained physicians in two, and one did not mention level of training. All studies were conducted in high-income settings. LUS took a maximum of 13 minutes to conduct. Nine studies used a 3.5-5 MHz micro-convex transducer and one used a 5–9 MHz convex probe. Pooled sensitivity and specificity for the diagnosis of pneumonia using LUS were 94% (95% CI, 92%-96%) and 96% (94%-97%), respectively; pooled positive and negative LRs were 16.8 (7.7-37.0) and 0.07 (0.05-0.10), respectively; and, the area-under-the-ROC curve was 0.99 (0.98-0.99). Conclusions Our meta-analysis supports that LUS, when conducted by highly-skilled sonographers, performs well for the diagnosis of pneumonia. General practitioners and Emergency Medicine physicians should be encouraged to learn LUS since it appears to be an established diagnostic tool in the hands of experienced physicians.
              Article 0 comments Cited 124 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2015
                Publication date (Electronic): 19 May 2015
                Volume: 5
                Issue: 5
                Electronic Location Identifier: e007838
                Affiliations
                [1 ]Department of Allergy Immunology and Respiratory Medicine, Alfred Hospital , Melbourne, Victoria, Australia
                [2 ]Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust , Oxford, UK
                [3 ]Bodleian Health Care Libraries, University of Oxford , Oxford, UK
                [4 ]Oxford Respiratory Trials Unit, University of Oxford , Oxford, UK
                [5 ]Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford, UK
                Author notes
                [Correspondence to ] Dr Mark Hew; m.hew@ 123456alfred.org.au
                Article
                Publisher ID: bmjopen-2015-007838
                DOI: 10.1136/bmjopen-2015-007838
                PMC ID: 4442194
                PubMed ID: 25991460
                SO-VID: 500f9094-9d90-4f02-a4c5-1a97ded8c371
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 4 February 2015
                Date revision received : 17 April 2015
                Date accepted : 21 April 2015
                Categories
                Subject: Respiratory Medicine
                Subject: Research
                Subject: 1506
                Subject: 1731
                Subject: 1694
                Subject: 1726
                Subject: 1707
                Subject: 1731
                Subject: 1730

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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