Document Type : Original Article
Authors
- Moloud Balafar 1
- Mahboub Pouraghaei 2
- Mahnaz Ranjkesh 3
- Mahshid Dehghan 4
- Ali Delkhorrami 4
- Samad Shams Vahdati 5
1 emergency medicine research team, Tabriz University of medical sciences
2 Gastrointestinal and Liver Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
3 Assistant Professor of Radiology, Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran.
4 The Emergency and Trauma Care Research Center, Emergency Department, Tabriz University of Medical Sciences, Tabriz, Iran.
5 Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IR Iran
Abstract
Objective: According to the most recent guidelines, the recommended imaging approaches for the diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However, there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attention in intensive care units (ICUs) and emergency departments. Considering the importance of the timely diagnosis and proper treatment of pneumonia, this study aimed to determine the diagnostic value of bedside LUS in comparison to chest CT scans in patients with suspected pneumonia or unspecified CXR findings in the emergency department.
Methods: This prospective descriptive-analytic study was conducted in the emergency department of Imam Reza hospital. Patients aged 3 years and older with early diagnosis of pneumonia or any unspecified CXR findings with an indication of CT scan were included in the study. LUS was performed with a deep curved and linear surface probe. The results obtained from the chest ultrasound were compared with the results obtained by CT scan as the diagnostic gold standard.
Results: A total of 175 patients were included in this study. According to the results, the sensitivity and specificity of LUS in the diagnosis of subpleural consolidation were 94.1% and 100%, respectively, and the positive predictive value and the negative predictive value were 100% and 33.3%, respectively. The sensitivity and specificity of LUS in diagnosing pleural effusion were 69.2% and 100%, respectively, and the positive predictive value and the negative predictive value were 100% and 90.7%, respectively. Furthermore, the sensitivity of LUS in diagnosing dynamic air
bronchogram was 98%.
Conclusion: According to the findings of the present study, in patients suspected of pneumonia, LUS is more sensitive and specific in the diagnosis of pneumonia and is less time-intensive and costly. Additionally, the ultrasound device is easily portable and accessible. It can be widely used and does not have the secondary side effects of ionizing radiation in patients. However, the technician’s skill in performing ultrasound is a matter of importance.
Keywords
Main Subjects
10.1056/NEJMcp1214869.
2. Eccles S, Pincus C, Higgins B, Woodhead M. Diagnosis and management of community and hospital acquired pneumonia in adults: summary of NICE guidance. BMJ. 2014;349:g6722. doi: 10.1136/bmj.g6722.
3. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with
hospital-acquired, ventilator-associated, and healthcareassociated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416. doi: 10.1164/rccm.200405-644ST.
4. Chavez MA, Shams N, Ellington LE, Naithani N, Gilman RH, Steinhoff MC, et al. Lung ultrasound for the diagnosis of
pneumonia in adults: a systematic review and meta-analysis.Respir Res. 2014;15(1):50. doi: 10.1186/1465-9921-15-50 .
5. Claessens YE, Debray MP, Tubach F, Brun AL, Rammaert B, Hausfater P, et al. Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community-acquired pneumonia. Am J Respir Crit Care Med.2015;192(8):974-82. doi: 10.1164/rccm.201501-0017OC.
6. Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a
meta-analysis. Chest. 2011;140(4):859-66. doi: 10.1378/chest.10-2946.
7. Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015;386(9998):1097-108. doi: 10.1016/
s0140-6736(15)60733-4.
8. Xia Y, Ma Y, Arias S, Lee H, Wang KP. Utilization of the International Association for the Study of Lung Cancer and
Wang’s nodal map for the identification of mediastinum and hilar lymph nodes. Thorac Cancer. 2015;6(4):464-8. doi:
10.1111/1759-7714.12206.
9. Xia Y, Zhang B, Zhang H, Li W, Wang KP, Shen H. Evaluation of lymph node metastasis in lung cancer: who is the chief justice? J Thorac Dis. 2015;7(Suppl 4):S231-7. doi: 10.3978/j.issn.2072-1439.2015.11.63.
10. Knox S, Madruga M, Carlan SJ. Utilizing abdominal sonography in the diagnosis of ascites caused by heart failure:
a patient with cirrhosis. J Diagn Med Sonogr. 2018;34(1):50-2.doi: 10.1177/8756479317727504.
systematic review. Sao Paulo Med J. 2010;128(2):90-5. doi: 10.1590/s1516-31802010000200009 .
12. Knudtson JL, Dort JM, Helmer SD, Smith RS. Surgeonperformed ultrasound for pneumothorax in the trauma
suite. J Trauma. 2004;56(3):527-30. doi: 10.1097/01.ta.0000114529.99353.22.
13. Benci A, Caremani M, Menchetti D, Magnolfi AL. Sonographic diagnosis of pneumonia and bronchopneumonia. Eur
J Ultrasound. 1996;4(3):169-76. doi: 10.1016/S0929- 8266(96)00195-4.
14. Ticinesi A, Lauretani F, Nouvenne A, Mori G, Chiussi G, Maggio M, et al. Lung ultrasound and chest X-ray for detecting pneumonia in an acute geriatric ward. Medicine (Baltimore). 2016;95(27):e4153. doi: 10.1097/md.0000000000004153.
15. Taylor GA, Eichelberger MR, Potter BM. Hematuria. A marker of abdominal injury in children after blunt trauma. Ann Surg.1988;208(6):688-93. doi: 10.1097/00000658-198812000-00003.
16. Ala AR, Pouraghaei M, Shams Vahdati S, Taghizadieh A, Moharamzadeh P, Arjmandi H. Diagnostic Accuracy of
Focused Assessment With Sonography for Trauma in the Emergency Department. Trauma Mon. 2016;21(4):e21122.
doi:10.5812/traumamon.21122.
17. 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):379-84. doi: 10.1016/j.ajem.2008.03.009.
18. Garofalo G, Busso M, Perotto F, De Pascale A, Fava C. Ultrasound diagnosis of pneumothorax. Radiol Med.
2006;111(4):516-25. doi: 10.1007/s11547-006-0047-y.
19. Reissig A, Kroegel C. Accuracy of transthoracic sonography in excluding post-interventional pneumothorax and
hydropneumothorax. Comparison to chest radiography. Eur J Radiol. 2005;53(3):463-70. doi:10.1016/j.ejrad.2004.04.014.
20. Lardinois D, Krueger T, Dusmet M, Ghisletta N, Gugger M, Ris HB. Pulmonary function testing after operative stabilisation of the chest wall for flail chest. Eur J Cardiothorac Surg. 2001;20(3):496-501. doi: 10.1016/s1010-7940(01)00818-1.
21. Tajoddini S, Shams Vahdati S. Ultrasonographic diagnosis of abdominal free fluid: accuracy comparison of emergency physicians and radiologists. Eur J Trauma Emerg Surg. 2013;39(1):9-13. doi:10.1007/s00068-012-0219-5.
)