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01.12.2014 | Research | Ausgabe 1/2014 Open Access

Respiratory Research 1/2014

Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

Zeitschrift:
Respiratory Research > Ausgabe 1/2014
Autoren:
Miguel A Chavez, Navid Shams, Laura E Ellington, Neha Naithani, Robert H Gilman, Mark C Steinhoff, Mathuram Santosham, Robert E Black, Carrie Price, Margaret Gross, William Checkley
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1465-9921-15-50) contains supplementary material, which is available to authorized users.

Competing interest

The authors declare that they have no competing interests.

Authors’ contribution

WC and MC conceived the original study design and were responsible for study conduct. CP and MG conducted public database search based on keywords developed by WC and MC. MC and NS conducted review of published papers and abstraction of data. RG, MSt, MSa, RB provided expert guidance of pneumonia research, analysis and interpretation. LE and NN contributed to writing and interpretation of data. All authors contributed equally to the analysis, interpretation of results, and writing of manuscript. WC had ultimate oversight over study conduct, analysis plan and writing of manuscript. All authors read and approved the final manuscript.

Abstract

Background

Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pneumonia. We conducted a meta-analysis to summarize existing evidence of the diagnostic accuracy of LUS for pneumonia in adults.

Methods

We conducted a systematic search of published studies comparing the diagnostic accuracy of LUS against a referent CXR or chest CT scan and/or clinical criteria for pneumonia in adults aged ≥18 years. Eligible studies were required to have a CXR and/or chest CT scan at the time of evaluation. We manually extracted descriptive and quantitative information from eligible studies, and calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled positive and negative likelihood ratios (LR) using the DerSimonian-Laird method. We assessed for heterogeneity using the Q and I2 statistics.

Results

Our initial search strategy yielded 2726 articles, of which 45 (1.7%) were manually selected for review and 10 (0.4%) were eligible for analyses. These 10 studies provided a combined sample size of 1172 participants. Six studies enrolled adult patients who were either hospitalized or admitted to Emergency Departments with suspicion of pneumonia and 4 studies enrolled critically-ill adult patients. LUS was performed by highly-skilled sonographers in seven studies, by trained physicians in two, and one did not mention level of training. All studies were conducted in high-income settings. LUS took a maximum of 13 minutes to conduct. Nine studies used a 3.5-5 MHz micro-convex transducer and one used a 5–9 MHz convex probe. Pooled sensitivity and specificity for the diagnosis of pneumonia using LUS were 94% (95% CI, 92%-96%) and 96% (94%-97%), respectively; pooled positive and negative LRs were 16.8 (7.7-37.0) and 0.07 (0.05-0.10), respectively; and, the area-under-the-ROC curve was 0.99 (0.98-0.99).

Conclusions

Our meta-analysis supports that LUS, when conducted by highly-skilled sonographers, performs well for the diagnosis of pneumonia. General practitioners and Emergency Medicine physicians should be encouraged to learn LUS since it appears to be an established diagnostic tool in the hands of experienced physicians.
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