Diagnostic Accuracy of Bedside Lung Ultrasound and Chest Radiography Compared to Thoracic Computed Tomography in Critically Ill Patients

Abstract

Bedside lung ultrasound (LUS) is being adopted in ICUs, with a higher diagnostic accuracy for consolidation, interstitial syndrome, pleural effusion, and pneumothorax when compared with chest radiography (CXR). Compare the diagnostic performance of LUS and CXR for the detection of pathologic abnormalities in critically ill patients in ICU, using thoracic computed tomography (CT) as a gold standard. Prospective and descriptive single-center study. Prior to CT, we performed bedside LUS and CXR, evaluating hemithoraces and characterized them as positive or negative for each of four abnormalities (consolidation syndrome, interstitial syndrome, pleural effusion, and pneumothorax). We decided therapeutic intervention after CT. A total of 58 patients were evaluated. With CT, consolidation was present in 100 (89.3%) of the evaluated hemithoraces, followed by pleural effusion in 74 (66.1%), interstitial syndrome in 40 (35.7%), and pneumothorax in 4 (3.6%). LUS performed better than CXR, exhibiting significantly higher sensitivity for all conditions. CXR had a marginally higher specificity than LUS for consolidation, interstitial syndrome, and pneumothorax. In 42 (72%) patients, imaging studies led to a specific action; in 33 (79%) patients, a subsequent measure was performed based on the information provided by LUS. In critically ill patients, bedside LUS shows better diagnostic performance than CXR for the diagnosis of common pathologic conditions and could be an alternative to CT scans.