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VOLUME 26 , ISSUE 8 ( August, 2022 ) > List of Articles

Original Article

Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units

Jonny Dhawan

Keywords : Bedside lung ultrasound, Chest X-ray, Computed tomography scan, Diagnosis, Pneumonia

Citation Information : Dhawan J. Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units. Indian J Crit Care Med 2022; 26 (8):920-929.

DOI: 10.5005/jp-journals-10071-24283

License: CC BY-NC 4.0

Published Online: 30-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Diagnosing pneumonia is challenging because of multiple differential diagnosis. Bedside lung ultrasound (BLUS) is a safe, portable, rapid and inexpensive new modality to diagnose pneumonia. This study was aimed to evaluate the sensitivity of BLUS vs chest X-ray (CXR) to diagnose community-acquired pneumonia (CAP) using computed tomography (CT) scans as the gold standard. Patients and methods: An observational cross-sectional study was conducted in selected intensive care units (ICUs). Eligible 85 adult patients with symptoms suggestive of pneumonia as per 2007 Infectious Disease Society of America (IDSA), American Thoracic Society (ATS) criteria, and 2D echocardiography were enrolled consecutively by using convenient sampling technique. Real-time reverse transcription-polymerase chain reaction (RT-PCR) assay for SARS-associated coronavirus was sent with in 1 hour followed by BLUS and CXR within 24 hours of ICU admission. The final confirmation of CAP was done by a thoracic CT scan. Results: Bedside lung ultrasound vs CXR could detect 74 vs 58 cases out of 84 confirmed cases. Sensitivity and specificity of BLUS vs CXR was 88.1% vs 67.8% and 100% vs 0%, respectively. Moreover, LR+ and LR− for BLUS was found to be 0 and 0.12 in comparison to 0.68 and 0 for CXR. The area under receiver operator characteristics (ROC) curve for BLUS vs CXR was 0.94 (95% CI 0.0–1.0) with p = 0.13 and 0.66 (95% CI 0.12–1.0) with p = 0.58. There was a significant agreement between diagnostic accuracy of BLUS and CT scan [kappa value (κ) = 0.14, p = 0.009], whereas CXR could not establish its diagnostic efficiency (κ = −0.023, p = 0.493). Sonographic features of pneumonia were B-lines, shred, and hepatization signs. Conclusion: It is observed that BLUS showed higher sensitivity, specificity, and diagnostic accuracy as compared to CXR to diagnose pneumonia.


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  1. Long L, Zhao HT, Zhang ZY, Wang GY, Zhao HL. Lung ultrasound for the diagnosis of pneumonia in adults: a meta-analysis. Medicine (Baltimore) 2017;96(3):e5713. DOI: 10.1097/MD.0000000000005713.
  2. Syrjala H, Broas M, Suramo I, Ojala A, Lähde S. High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis 1998;27(2):358–363. DOI: 10.1086/514675.
  3. Self WH, Courtney DM, McNaughton CD, Wunderink RG, Kline JA. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med 2013;31(2):401–405. DOI: 10.1016/j.ajem.2012.08.041.
  4. Esayag Y, Nikitin I, Bar–Ziv J, Cytter R, Hadas–Halpern I, Zalut T, et al. Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia. Am J Emerg Med 2010;123(1): 88-e1–5. DOI: 10.1016/j.amjmed.2009.09.012.
  5. Hagaman JT, Rouan GW, Shipley RT, Panos RJ. Admission chest radiograph lacks sensitivity in the diagnosis of community-acquired pneumonia. Am J Med Sci 2009;337(4):236–240. DOI: 10.1097/MAJ.0b013e31818ad805.
  6. Ye X, Xiao H, Chen B, Zhang S. Accuracy of lung ultrasonography versus chest radiography for the diagnosis of adult community-acquired pneumonia: review of the literature and meta-analysis. PloS One 2015;10(6):e0130066. DOI: 10.1371/journal.pone.0130066.
  7. Liu XL, Lian R, Tao YK, Gu CD, Zhang GQ. Lung ultrasonography: an effective way to diagnose community-acquired pneumonia. Emerg Med J 2015;32(6):433–438. DOI: 10.1136/emermed-2013-203039.
  8. Lichtenstein DA. Ultrasound in the management of thoracic disease. Crit Care Med 2007;35(Suppl. 5):S250–S261. DOI: 10.1097/01.CCM.0000260674.60761.85.
  9. Bourcier JE, Paquet J, Seinger M, Gallard E, Redonnet JP, Cheddadi F, et al. Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED. The American journal of emergency medicine 2014;32(2):115–118. DOI: 10.1016/j.ajem.2013.10.003.
  10. Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J 2012;29(1):19–23. DOI: 10.1136/emj.2010.101584.
  11. Reissig A, Copetti R, Mathis G, Mempel C, Schuler A, Zechner P, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest 2012;142(4):965–972. DOI: 10.1378/chest.12-0364.
  12. Pereda MA, Chavez MA, Hooper–Miele CC, Gilman RH, Steinhoff MC, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics 2015;135(4):714–22. DOI: 10.1542/peds.2014-2833.
  13. Xia Y, Ying Y, Wang S, Li W, Shen H. Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis. J Thorac Dis 2016;8(10):2822–2831. DOI: 10.21037/jtd.2016.09.38.
  14. Samanta S, Patnaik R, Azim A, Gurjar M, Baronia AK, Poddar B, et al. Incorporating lung ultrasound in clinical pulmonary infection score as an added tool for diagnosing ventilator-associated pneumonia: a prospective observational study from a tertiary care center. Indian J Crit Care Med 2021;25(3):284–291. DOI: 10.5005/jp-journals-10071-23759.
  15. Amatya Y, Rupp J, Russell FM, Saunders J, Bales B, House DR. Diagnostic use of lung ultrasound compared to chest radiograph for suspected pneumonia in a resource-limited setting. Int J Emerg Med 2018;11(1):1–5. DOI: 10.1186/s12245-018-0170-2.
  16. Middleton WD, Kurtz AB, Hertzberg BS. Lower genitourinary. Middleton WD, Kurtz AB, Herzberg BS, editors. The Requisites Ultrasound. 2nd ed. St. Louis, MO: Mosby An Affiliate of Elsevier, Inc. 2004:152–190.
  17. Reissig A, Gramegna A, Aliberti S. The role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia. Eur J Int Med 2012;23(5):391–397. DOI: 10.1016/j.ejim.2012.01.003.
  18. Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care 2014;4(1):1–2. DOI: 10.1186/2110-5820-4-1.
  19. Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med 2009;27(4):379–384. DOI: 10.1016/j.ajem.2008.03.009.
  20. Bitar ZI, Maadarani OS, El–Shably AM, Al–Ajmi MJ. Diagnostic accuracy of chest ultrasound in patients with pneumonia in the intensive care unit: a single-hospital study. Health Sci Rep 2019;2(1):e102. DOI: 10.1002/hsr2.102.
  21. Moghawri MW, Mansour W, Lakouz KA, Hussein RM. Role of chest ultrasonography in the diagnosis and follow-up of community-acquired pneumonia at Zagazig University Hospitals. Egypt J Bronchol 2017;11(1):29–35. DOI: 10.4103/1687-8426.198991.
  22. Unluer EE, Karagoz A, Senturk GO, Karaman M, Olow KH, Bayata S. Bedside lung ultrasonography for diagnosis of pneumonia. Hong Kong Journal of Emergency Medicine 2013;20(2):98–104. DOI: 10.1177/102490791302000205.
  23. Gopaldas JA, Kumar AKA. Ventilator-associated pneumonia and lung ultrasound: finally, what is between the ears matters. Indian J Crit Care Med 2021;25(9):1075–1076. DOI: 10.5005/jp-journals-10071-23936.
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