Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis.

Xiong Ye,Hui Xiao,Bo Chen,Suiyang Zhang,James D Chalmers

doi:10.1371/journal.pone.0130066

Abstract

Lung ultrasonography (LUS) is being increasingly utilized in emergency and critical settings. We performed a systematic review of the current literature to compare the accuracy of LUS and chest radiography (CR) for the diagnosis of adult community-acquired pneumonia (CAP). We searched in Pub Med, EMBASE dealing with both LUS and CR for diagnosis of adult CAP, and conducted a meta-analysis to evaluate the diagnostic accuracy of LUS in comparison with CR. The diagnostic standard that the index test compared was the hospital discharge diagnosis or the result of chest computed tomography scan as a “gold standard”. We calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled diagnostic odds ratio using the DerSimonian-Laird method. Five articles met our inclusion criteria and were included in the final analysis. Using hospital discharge diagnosis as reference, LUS had a pooled sensitivity of 0.95 (0.93-0.97) and a specificity of 0.90 (0.86 to 0.94), CR had a pooled sensitivity of 0.77 (0.73 to 0.80) and a specificity of 0.91 (0.87 to 0.94). LUS and CR compared with computed tomography scan in 138 patients in total, the Z statistic of the two summary receiver operating characteristic was 3.093 (P = 0.002), the areas under the curve for LUS and CR were 0.901 and 0.590, respectively. Our study indicates that LUS can help to diagnosis adult CAP by clinicians and the accuracy was better compared with CR using chest computed tomography scan as the gold standard.

Highlights

Community-acquired pneumonia (CAP) is a major health problem worldwide, failure of early detection and distribution of treatment may lead to significant morbidity and mortality [1]
Among the 742 patients in the five studies, chest computed tomography (CT) scans were performed in 71 patients with equivocal or negative radiographic but positive Lung ultrasonography (LUS) results in two studies [19,21], and in other three studies CT scans were obtained when considered clinically indicated or due to difficult diagnosis in 67 patients [20,22,23]
All of the included studies passed most of the fourteen Quality Assessment of Diagnostic Accuracy Studies (QUADAS) items, Table 2 summarizes the four informative questions, and the other ten which did not differ between studies were ‘positive’ answers that did not introduce significant bias

Summary

Introduction

Community-acquired pneumonia (CAP) is a major health problem worldwide, failure of early detection and distribution of treatment may lead to significant morbidity and mortality [1]. Ultrasound Detect Adult Community-Acquired Pneumonia: A Meta-Analysis a patient suspected of pneumonia, but CR has been demonstrated to be an insensitive method with relatively low accuracy[2,3]. S and his colleagues evaluated the use of CR with computed tomography (CT) scanning for detection of pulmonary opacities[4]. Thoracic CT scan is considered the “gold standard” for detection of pneumonia and other pulmonary lesions, but it cannot be used as a first-line radiological examination in all patients with suspected pneumonia. This is mainly due to the fact that it is often costly, not available and that it involves a high radiation dose [5]

Methods

Results

Conclusion