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Abstract
To assess the usefulness of lung ultrasound (LUS) for identifying community-acquired pneumonia (CAP) among adult patients with suspected lower respiratory tract infection (LRTI) and for discriminating between CAP with different cultural statuses, etiologies, and outcomes. LUS was performed at internal medicine ward admission. The performance of chest X-ray (CXR) and LUS in diagnosing CAP in 410 patients with suspected LRTI was determined. All possible positive results for pneumonia on LUS were condensed into pattern 1 (consolidation + / − alveolar-interstitial syndrome) and pattern 2 (alveolar-interstitial syndrome). The performance of LUS in predicting culture-positive status, bacterial etiology, and adverse outcomes of CAP was assessed in 315 patients. The area under the receiver operating characteristic curve for diagnosing CAP by LUS was significantly higher than for diagnosis CAP by CXR (0.93 and 0.71, respectively; p < 0.001). Pattern 1 predicted CAP with bacterial and mixed bacterial and viral etiologies with positive predictive values of 99% (95% CI, 94–100%) and 97% (95% CI, 81–99%), respectively. Pattern 2 ruled out mortality with a negative predictive value of 95% (95% CI, 86–98%), respectively. In this study, LUS was useful in predicting a diagnosis of CAP, the bacterial etiology of CAP, and favorable outcome in patients with CAP.
Highlights
FM and CC have at least 8 years of experience with point-of-care ultrasonography; they were blinded to all clinical data except for the fact that lower respiratory tract infection (LRTI) was suspected
A total of 410 patients underwent both chest X-ray (CXR) and lung ultrasound (LUS) at internal medicine ward (IMW) admission and were included in the first analysis (Fig. 1a); their clinical characteristics are shown in Table S1
This study assessed the usefulness of LUS performed at hospital admission in supporting physicians in several aspects of community-acquired pneumonia (CAP) management from diagnosis through the identification of patients in whom cultures are likely/ unlikely to provide useful diagnostic information and of patients in whom empirical antibacterial therapy is mandatory to prognostication
Summary
Second analysis: to identify the LUS features that, at hospital admission, could be predictive of 1) a specific cultural status, 2) the need for empirical antibacterial therapy, and 3) the need to escalate/de-escalate the intensity of treatment in patients with a definitive diagnosis of CAP. The number of positive and negative results for CAP of both CXR and LUS were put side by side in patients with suspected LRTI. The frequency of each LUS result (positive/negative) and positive pattern (pattern 1 and pattern 2) were compared in the following cohorts: 1) patients with culture-positive CAP vs those with all culture-negative CAP, 2) patients with all bacterial CAP vs those with viral CAP and CAP due to coinfection vs those with viral CAP, and 3) deteriorating patients vs nondeteriorating patients with CAP and nonsurviving vs surviving patients with CAP. All the analyses were performed using SPSS statistical package, version 20.0 (Armonk, NY: IBM Corp)
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