Staub Leonardo Jönck, Mazzali Biscaro Roberta Rodolfo, Kaszubowski Erikson, Maurici Rosemeri
Emergency Department of the University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
Intensive Care Unit of the University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
J Emerg Med. 2019 Jan;56(1):53-69. doi: 10.1016/j.jemermed.2018.09.009. Epub 2018 Oct 9.
Lung ultrasound can accelerate the diagnosis of life-threatening diseases in adults with respiratory symptoms.
Systematically review the accuracy of lung ultrasonography (LUS) for emergency diagnosis of pneumonia, acute heart failure, and exacerbation of chronic obstructive pulmonary disease (COPD)/asthma in adults.
PubMed, Embase, Scopus, Web of Science, and LILACS (Literatura Latino Americana e do Caribe em Ciências da Saúde; until 2016) were searched for prospective diagnostic accuracy studies. Rutter-Gatsonis hierarchical summary receiver operating characteristic method was used to measure the overall accuracy of LUS and Reitsma bivariate model to measure the accuracy of the different sonographic signs. This review was previously registered in PROSPERO (Centre for Reviews and Dissemination, University of York, York, UK; CRD42016048085).
Twenty-five studies were included: 14 assessing pneumonia, 14 assessing acute heart failure, and four assessing exacerbations of COPD/asthma. The area under the summary receiver operating characteristic curve of LUS was 0.948 for pneumonia, 0.914 for acute heart failure, and 0.906 for exacerbations of COPD/asthma. In patients suspected to have pneumonia, consolidation had sensitivity of 0.82 (95% confidence interval [CI] 0.74-0.88) and specificity of 0.94 (95% CI 0.85-0.98) for this disease. In acutely dyspneic patients, modified diffuse interstitial syndrome had sensitivity of 0.90 (95% CI 0.87-0.93) and specificity of 0.93 (95% CI 0.91-0.95) for acute heart failure, whereas B-profile had sensitivity of 0.93 (95% CI 0.72-0.98) and specificity of 0.92 (95% CI 0.79-0.97) for this disease in patients with respiratory failure. In patients with acute dyspnea or respiratory failure, the A-profile without PLAPS (posterior-lateral alveolar pleural syndrome) had sensitivity of 0.78 (95% CI 0.67-0.86) and specificity of 0.94 (95% CI 0.89-0.97) for exacerbations of COPD/asthma.
Lung ultrasound is an accurate tool for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of COPD/asthma.
肺部超声可加快对有呼吸道症状的成人危及生命疾病的诊断。
系统评价肺部超声检查（LUS）对成人肺炎、急性心力衰竭及慢性阻塞性肺疾病（COPD）/哮喘急性加重的急诊诊断准确性。
检索PubMed、Embase、Scopus、Web of Science和LILACS（拉丁美洲及加勒比地区卫生科学文献数据库；截至2016年），查找前瞻性诊断准确性研究。采用Rutter-Gatsonis分层汇总受试者工作特征方法测量LUS的总体准确性，采用Reitsma双变量模型测量不同超声征象的准确性。本综述先前已在PROSPERO（英国约克大学综述与传播中心；CRD42016048085）注册。
纳入25项研究：14项评估肺炎，14项评估急性心力衰竭，4项评估COPD/哮喘急性加重。LUS汇总受试者工作特征曲线下面积，肺炎为0.948、急性心力衰竭为0.914、COPD/哮喘急性加重为0.906。在疑似肺炎患者中，实变对此病的敏感性为0.82（95%置信区间[CI]0.74 - 0.88），特异性为0.94（95%CI 0.85 - 0.98）。在急性呼吸困难患者中，改良弥漫性间质综合征对急性心力衰竭的敏感性为0.90（95%CI 0.87 - 0.93），特异性为0.93（95%CI 0.91 - 0.95）；而在呼吸衰竭患者中，B线对急性心力衰竭的敏感性为0.93（95%CI 0.72 - 0.98），特异性为0.92（95%CI 0.79 - 0.97）。在急性呼吸困难或呼吸衰竭患者中，无PLAPS（后外侧肺泡胸膜综合征）的A线对COPD/哮喘急性加重的敏感性为0.78（95%CI 0.67 - 0.86），特异性为0.94（95%CI 0.89 - 0.97）。
肺部超声是肺炎、急性心力衰竭及COPD/哮喘急性加重急诊诊断的准确工具。
