Accuracy and clinical impact of point-of-care lung ultrasound performed by respiratory physicians

Abstract

Background: Despite theoretical usefulness of point-of-care lung ultrasonography in numerous diseases, indications, impact and accuracy of the technique is unknown. Methods: A two years prospective observational study was performed by pulmonologists of Italian University Hospital. Technique, clinical indications, consequences of lung ultrasound and barriers to the ultrasound examination were analyzed. Overall accuracy of lung ultrasound was calculated for all the first diagnoses of lung consolidation, interstitial syndrome, and pneumothorax, by comparing the ultrasound pattern with the adjudicated final clinical diagnosis based on a hospital chart review. Results: 1150 lung ultrasounds were performed. The most common indications were diagnosis and follow-up of pleural effusion in 361 cases (31%), evaluation of lung consolidation (322, 28%), acute heart failure (195, 17%), guide to pleural procedures (117, 10%), pneumothorax (54, 5%) and acute exacerbations of chronic obstructive pulmonary disease (30, 3%). The mean duration time of the examination was 6 ± 4 minutes. Ultrasound correctly identified the final diagnosis in 564/574 cases (98%, IC 95%, 97% - 99%). According to the judgment of the caring clinician, 51% of the exams were clinically relevant. Conclusions: Lung ultrasound performed at the point-of-care by pulmonologists is a rapid and accurate clinical tool.