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Original Research |

Accuracy of lung ultrasound in the diagnosis of pneumonia in adults: systematic review and meta-analysis

Ana M. Llamas-Álvarez, MD; Eva M. Tenza-Lozano, MD; Jaime Latour-Pérez, MD, PhD
Author and Funding Information

CONFLICT OF INTEREST: The authors have no conflicts of interest to declare.

FUNDING/SUPPORT: Department of Clinical Medicine, Miguel Hernández University.

PRIOR ABSTRACT PUBLICATION/PRESENTATION: No.

IRB APPROVAL/ PATIENT CONSENT: not provided as this is a review of previously published studies. No patients were enrolled.

aIntensive Care Unit, Elche General University Hospital, Elche, Spain

bDepartment of Clinical Medicine, Miguel Hernández University, Sant Joan d’Alacant, Spain

Correspondence to: Ana Llamas-Álvarez, Department of Intensive Care Medicine, Elche General University Hospital, Camino de la Almazara 11, 03203, Elche, Spain.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.039
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Published online

Abstract

Background  Some studies suggest that lung ultrasound could be useful for diagnosing pneumonia; moreover, it has a more favorable safety profile and lower cost than chest X-ray (CXR) and computed tomography (CT). The aim of this study is to assess the accuracy of bedside lung ultrasound 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 (QUADAS-2) tool. The summary receiver operating characteristics (SROC) curve and a pooled estimation of the diagnostic odds ratio (DOR) was estimated using using a bivariate random-effects analysis. The sources of heterogeneity were explored using predefined subgroup analyses and bivariate meta-regression.

Results  Sixteen studies (2359 participants) were included. There was significant heterogeneity of both sensitivity and specificity according to 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% confidence interval (CI): 21, 120). A tendency towards 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 ultrasound can help to accurately diagnose pneumonia, and it may be promising as an adjuvant resource to traditional approaches.


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