Abstract
Introduction: There is debate as to whether lung-ultrasound (LUS) can replace lung-auscultation (LA) in the assessment of respiratory diseases. Methodology: The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. Standard formulas were used to calculate the diagnostic sensitivity, specificity, and accuracy. The interobserver agreement with respect to the LA and LUS findings was evaluated based on the Kappa coefficient (ᴋ). Results: A total of 115 patients were studied. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs. 77.02%; p = 0.001) and more specifically in the case of decompensated obstructive airway diseases (95.6% vs. 19.10%; p = 0.001). The diagnostic accuracy of LUS was also greater in the case of pulmonary infections (75.65% vs. 60.90%; p = 0.02). The sensitivity and specificity of the combination of LA and LUS was 95.95%, 50% in pulmonary infections, 76.19%, 100% in case of decompensated obstructive airway diseases, and (100%, 88.54%) in case of interstitial diseases. (ᴋ) was 0.71 for an A-pattern, 0.73 for pathological B-lines, 0.94 for condensations, 0.89 for pleural-effusion, 0.63 for wheezes, 0.38 for rhonchi, 0.68 for fine crackles, 0.18 for coarse crackles, and 0.29 for a normal LA. Conclusions: There is a greater interobserver agreement in the interpretation of LUS-findings compared to that of LA-noises, their combined use improves diagnostic performance in all diseases examined.
Highlights
There is debate as to whether lung-ultrasound (LUS) can replace lungauscultation (LA) in the assessment of respiratory diseases
On the premise that LUS should be considered the fifth fundamental pillar of physical examination, as an enhancer of the traditional examination, we propose this study with the following two objectives: first, to compare the diagnostic yield of LA and LUS for the diagnosis of different respiratory diseases for which patients are frequently admitted to Pulmonology wards and, second, to determine the interobserver variability when interpreting the different sounds detected during an LA and the images identified in an LUS, as this aspect has not yet been rigorously studied
In 22 (19.1%) patients, the final diagnosis was decompensation of their underlying obstructive disease, with 17 (77.3%) of these cases corresponding to a decompensated chronic obstructive pulmonary disease (COPD) and five (22.7%) to an asthma attack
Summary
There is debate as to whether lung-ultrasound (LUS) can replace lungauscultation (LA) in the assessment of respiratory diseases. Methodology: The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs 77.02%; p = 0.001). One of the most widely used instruments in physical examinations is the stethoscope, which was developed in 1816 by French physician Laënnec [1]. This tool has become an important emblem of medicine and is a key element of the physical examination of patients with respiratory diseases [2,3]. From an etymological point of view, this tool is considered to be the real stethoscope, as stethos is a Greek prefix that refers to the thorax, while skopein, another
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