Chest
Original Research: ImagingAccuracy of Lung Ultrasonography in the Diagnosis of Pneumonia in Adults: Systematic Review and Meta-Analysis
Section snippets
Search Strategy and Study Selection
We included studies in people aged 18 years and older with clinical suspicion or confirmed diagnosis of pneumonia, comparing lung ultrasonography and other diagnostic strategies, including chest radiography or CT, or both, as the imaging technique. We considered both community-acquired and nosocomial alveolar and interstitial pneumonia, including ventilator-associated pneumonia. Studies related to eosinophilic pneumonia were excluded given their different characteristics and causes.
The
Characteristics of Included Studies
The initial literature search yielded a total of 2,812 studies, 16 of which met the inclusion criteria and were included in the qualitative and quantitative synthesis (Fig 1).
The predominant design was the cohort study (Tables 1 and 2),29, 30, 31 and all took place between 2008 and 2015. Most studies were European, and altogether they involved a total of 2,359 participants. Although CT is traditionally considered the reference test for diagnosing pneumonia, it is not applied systematically
Discussion
The results of this study suggest that bedside lung ultrasonography has excellent accuracy for the diagnosis of pneumonia in adults. Although most of the included studies have problems regarding risk of bias, the high accuracy of lung ultrasonography does not appear to be attributable to the poor quality of the studies, since when stratifying by the different dimensions of QUADAS-2, test accuracy is numerically better in high-quality studies.
Our findings are consistent with previous reviews
Conclusions
Lung ultrasonography has high sensitivity and specificity and appears to be a valuable complement to chest radiography for the diagnosis of pneumonia in adults.
Acknowledgments
Author contributions: A. M. L-A is guarantor for the entire manuscript. A. M. L-A had full access to all the data in the study; takes responsibility for the integrity of the data and the accuracy of the data analysis; contributed to the study concept and design, the literature search, data analysis, and drafting of the manuscript; and served as principal author. E. M. T-L. contributed to the literature search. J. L-P. contributed to the study design, statistical analysis, and revision of the
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FUNDING/SUPPORT: This work was supported by the Department of Clinical Medicine, Miguel Hernández University.