Chest
Volume 151, Issue 2, February 2017, Pages 374-382
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Original Research: Imaging
Accuracy of Lung Ultrasonography in the Diagnosis of Pneumonia in Adults: Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.chest.2016.10.039Get rights and content

Background

Some studies suggest that lung ultrasonography could be useful for diagnosing pneumonia; moreover, it has a more favorable safety profile and lower cost than chest radiography and CT. The aim of this study was to assess the accuracy of bedside lung ultrasonography for diagnosing pneumonia in adults through a systematic review and meta-analysis.

Methods

We searched MEDLINE, Scopus, The Cochrane Library, Web of Science, DARE, HTA Database, Google Scholar, LILACS, ClinicalTrials.gov, TESEO, and OpenGrey. In addition, we reviewed the bibliographies of relevant studies. Two researchers independently selected studies that met the inclusion criteria. Quality of the studies was assessed in accordance with the Quality Assessment of Diagnostic Accuracy Studies tool. The summary receiver operating characteristic (SROC) curve and a pooled estimation of the diagnostic odds ratio (DOR) was estimated using a bivariate random-effects analysis. The sources of heterogeneity were explored using predefined subgroup analyses and bivariate meta-regression.

Results

Sixteen studies (2,359 participants) were included. There was significant heterogeneity of both sensitivity and specificity according to the Q test, without clear evidence of threshold effect. The area under the SROC curve was 0.93, with a DOR at the optimal cutpoint of 50 (95% CI, 21-120). A tendency toward a higher area under the SROC curve in high-quality studies was detected; however, these differences were not significant after applying the bivariate meta-regression.

Conclusions

Lung ultrasonography can help accurately diagnose pneumonia, and it may be promising as an adjuvant resource to traditional approaches.

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.

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