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Desai D, Shah AB, Dela JRC, Mugibel TA, Sumaily KM, Sabi EM, Mujamammi AH, Malafi ME, Alkaff SA, Alwahbi TA, Bahabara JO, Dahman LSB. Lung Ultrasonography Accuracy for Diagnosis of Adult Pneumonia: Systematic Review and Meta-Analysis. Adv Respir Med 2024; 92:241-253. [PMID: 38921063 PMCID: PMC11200838 DOI: 10.3390/arm92030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Pneumonia is a ubiquitous health condition with severe outcomes. The advancement of ultrasonography techniques allows its application in evaluating pulmonary diseases, providing safer and accessible bedside therapeutic decisions compared to chest X-ray and chest computed tomography (CT) scan. Because of its aforementioned benefits, we aimed to confirm the diagnostic accuracy of lung ultrasound (LUS) for pneumonia in adults. METHODS A systematic literature search was performed of Medline, Cochrane and Crossref, independently by two authors. The selection of studies proceeded based on specific inclusion and exclusion criteria without restrictions to particular study designs, language or publication dates and was followed by data extraction. The gold standard reference in the included studies was chest X-ray/CT scan or both. RESULTS Twenty-nine (29) studies containing 6702 participants were included in our meta-analysis. Pooled sensitivity, specificity and PPV were 92% (95% CI: 91-93%), 94% (95% CI: 94 to 95%) and 93% (95% CI: 89 to 96%), respectively. Pooled positive and negative likelihood ratios were 16 (95% CI: 14 to 19) and 0.08 (95% CI: 0.07 to 0.09). The area under the ROC curve of LUS was 0. 9712. CONCLUSIONS LUS has high diagnostic accuracy in adult pneumonia. Its contribution could form an optimistic clue in future updates considering this condition.
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Affiliation(s)
- Dev Desai
- Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Gujarat University, Ahmedabad 380006, India; (D.D.); (A.B.S.)
| | - Abhijay B. Shah
- Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Gujarat University, Ahmedabad 380006, India; (D.D.); (A.B.S.)
| | - Joseph Rem C. Dela
- College of Medicine, University of the Philippines, Manila 1000, Philippines;
| | - Tayba A. Mugibel
- College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen; (S.A.A.); (T.A.A.)
- Clinical Biochemistry Unit, Laboratory Medicine Department, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
| | - Khalid M. Sumaily
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (K.M.S.); (E.M.S.); (A.H.M.)
| | - Essa M. Sabi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (K.M.S.); (E.M.S.); (A.H.M.)
| | - Ahmed H. Mujamammi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (K.M.S.); (E.M.S.); (A.H.M.)
| | - Maria E. Malafi
- Medical School, Democritus University, 68100 Alexandroupolis, Greece;
| | - Sara A. Alkaff
- College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen; (S.A.A.); (T.A.A.)
- Clinical Biochemistry Unit, Laboratory Medicine Department, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
| | - Thurya A. Alwahbi
- College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen; (S.A.A.); (T.A.A.)
- Clinical Biochemistry Unit, Laboratory Medicine Department, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
| | - Jamal O. Bahabara
- Radiology Unit, Department of Specialized Surgery, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
| | - Lotfi S. Bin Dahman
- Clinical Biochemistry Unit, Laboratory Medicine Department, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
- Hadhramout Foundation—Human Development, Mukalla, Yemen
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Trovato G, Russo M. Artificial Intelligence (AI) and Lung Ultrasound in Infectious Pulmonary Disease. Front Med (Lausanne) 2021; 8:706794. [PMID: 34901048 PMCID: PMC8655241 DOI: 10.3389/fmed.2021.706794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Matteo Russo
- The European Medical Association (EMA), Brussels, Belgium
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Kameda T, Mizuma Y, Taniguchi H, Fujita M, Taniguchi N. Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era. J Med Ultrason (2001) 2021; 48:31-43. [PMID: 33438132 PMCID: PMC7803468 DOI: 10.1007/s10396-020-01074-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/15/2020] [Indexed: 12/12/2022]
Abstract
In the coronavirus disease-2019 (COVID-19) era, point-of-care lung ultrasound (LUS) has attracted increased attention. Prospective studies on LUS for the assessment of pneumonia in adult patients were extensively carried out for more than 10 years before this era. None of these prospective studies attempted to differentiate bacterial and viral pneumonia in adult patients using LUS. The majority of studies considered the LUS examination to be positive if sonographic consolidations or multiple B-lines were observed. Significant differences existed in the accuracy of these studies. Some studies revealed that LUS showed superior sensitivity to chest X-ray. These results indicate that point-of-care LUS has the potential to be an initial imaging modality for the diagnosis of pneumonia. The LUS diagnosis of ventilator-associated pneumonia in intensive care units is more challenging in comparison with the diagnosis of community-acquired pneumonia in emergency departments due to the limited access to the mechanically ventilated patients and the high prevalence of atelectasis. However, several studies have demonstrated that the combination of LUS findings with other clinical markers improved the diagnostic accuracy. In the COVID-19 era, many case reports and small observational studies on COVID-19 pneumonia have been published in a short period. Multiple B-lines were the most common and consistent finding in COVID-19 pneumonia. Serial LUS showed the deterioration of the disease. The knowledge and ideas on the application of LUS in the management of pneumonia that are expected to accumulate in the COVID-19 era may provide us with clues regarding more appropriate management.
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Affiliation(s)
- Toru Kameda
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. .,Department of Emergency Medicine, Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino-shi, Nagano, 399-8293, Japan.
| | - Yoshihiro Mizuma
- Department of Internal Medicine, Higashi Kobe Hospital, 1-24-13 Sumiyoshihonmachi, Higashinada-ku, Kobe-shi, Hyogo, 658-0051, Japan
| | - Hayato Taniguchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama-shi, Kanagawa, 232-0044, Japan
| | - Masato Fujita
- Department of Emergency Medicine, Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino-shi, Nagano, 399-8293, Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
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Trovato G. SEPSIS. Educational and Best Practice Frontiers. Beyond the Boundaries of Fatality, Enhancing Clinical Skills and Precision Medicine. Ther Clin Risk Manag 2020; 16:87-93. [PMID: 32103969 PMCID: PMC7024868 DOI: 10.2147/tcrm.s232530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/28/2020] [Indexed: 12/19/2022] Open
Abstract
Dissemination and exploitation of knowledge regarding affordable clinical skills and innovative precision medicine, two current topics in active development in medicine, may contribute to improve also sepsis management. Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. Sepsis is strongly related to all body organs or to systemic diseases and to the quality of the best-practice in use, which is particularly critical in surgical or intervention techniques. Trauma, surgical and mini-invasive procedures, vascular or endoscopic interventions, otolaryngology, obstetrics-gynecological and urological procedures, malnutrition, dental, skin, chronic liver, kidney and respiratory disease are frequently involved. Accordingly, apart from the clinical risk analysis and management of the process of care, the actual factors that may be easily neglected are the techniques used, the personal skills of the health professionals and the quality of the equipment. The quest for biomarkers consistent with the unmet needs of medical doctors and of their patient and the efforts for overcoming bacterial antibiotic resistances are currently the main foci of medical research. In addition, in this regard, research and innovation would benefit from greater knowledge, skills and use of bioinformatics and omics. The caveats related to in-silico approaches must be flagged: algorithms may equally warrant scientific innovations or hide the lack of them; a patient is more than a set of covariates. Epidemiology and prevention includes all the actions suitable for achieving an adequate hygiene and immunization of populations and for safer hospital policies and procedures during Patients’ stays. In any subset, the most unresolved critical point in sepsis is a timely diagnosis. This is impaired by low degrees of suspicion for the possibility of emerging sepsis, by the shortage of use of the simplest microbiological testing but, equally or more, by the insufficient diffusion of non-invasive imaging skills suitable to detect and monitor the emerging sites and sources of infection. In primary care, in emergency facilities, in hospital wards and in intensive care units, inclusion of appropriate knowledge, skills, expertise and imaging equipment must be extended as much as possible. The low cost of UltraSound machines and of increasing bioinformatics literacy by e-learning, makes such investments affordable even in limited-resources contexts. Frontier educational and best practice intervention enhancing affordable clinical skills and innovative precision medicine may lead beyond the boundaries of fatal outcomes in sepsis. ![]()
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Affiliation(s)
- Guglielmo Trovato
- The European Medical Association (EMA) and the School of Medicine, State University of Catania, Catania, Italy
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Evison M, Blyth KG, Bhatnagar R, Corcoran J, Saba T, Duncan T, Hallifax R, Ahmed L, West A, Pepperell JCT, Roberts M, Sivasothy P, Psallidas I, Clive AO, Latham J, Stanton AE, Maskell N, Rahman N. Providing safe and effective pleural medicine services in the UK: an aspirational statement from UK pleural physicians. BMJ Open Respir Res 2018; 5:e000307. [PMID: 30116537 PMCID: PMC6089266 DOI: 10.1136/bmjresp-2018-000307] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/30/2022] Open
Abstract
Physicians face considerable challenges in ensuring safe and effective care for patients admitted to hospital with pleural disease. While subspecialty development has driven up standards of care, this has been tempered by the resulting loss of procedural experience in general medical teams tasked with managing acute pleural disease. This review aims to define a framework though which a minimum standard of care might be implemented. This review has been written by pleural clinicians from across the UK representing all types of secondary care hospital. Its content has been formed on the basis of literature review, national guidelines, National Health Service England policy and consensus opinion following a round table discussion. Recommendations have been provided in the broad themes of procedural training, out-of-hours management and pleural service specification. Procedural competences have been defined into descriptive categories: emergency, basic, intermediate and advanced. Provision of emergency level operators at all times in all trusts is the cornerstone of out-of-hours recommendations, alongside readily available escalation pathways. A proposal for minimum standards to ensure the safe delivery of pleural medicine have been described with the aim of driving local conversations and providing a framework for service development, review and risk assessment.
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Affiliation(s)
- Matthew Evison
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth Hospital, Glasgow, UK.,Institute of Infection, Immunity of Inflammation, University of Glasgow, Glasgow, UK
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Corcoran
- Interventional Pulmonology Service, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Tarek Saba
- Respiratory Medicine, Blackpool Victoria Hospital, Blackpool, UK
| | - Tracy Duncan
- Pleural Service, North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK
| | - Liju Ahmed
- Respiratory Medicine, Guys and St. Thomas NHS Foundation Trust, London, UK.,Respiratory Medicine, Kings College School of Medicine, London, UK
| | - Alex West
- Respiratory Medicine, Guys and St. Thomas NHS Foundation Trust, London, UK
| | | | - Mark Roberts
- Respiratory Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK
| | - Amelia O Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | | | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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