Wang Liang, Song Wei, Wang Yong, Han Jie, Lv Ke
Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China.
Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China.
J Thorac Dis. 2019 Dec;11(12):5107-5114. doi: 10.21037/jtd.2019.11.62.
Pediatric community acquired pneumonia (pCAP) is a major public health and economic problem with a considerable impact on morbidity and mortality in children. Recently many studies and meta-analyses have shown promising results on the accuracy of lung ultrasonography (LU) in diagnosing pneumonia and potentially replacing chest radiography (CR) in pediatric population. However, previous studies establishing the accuracy of LU often used CR as reference standard and took into account different clinical settings all together. To make a more objective and specific analysis, we performed a systematic review and meta-analysis to compare the diagnostic accuracy of LU and CR for pCAP in the emergency department (ED) setting.
A literature search of PubMed and Embase databases up to December 2018 was conducted. Pooled sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio of LU and CR were calculated, and summary receiver operating characteristic (SROC) curves were drawn.
A total of six studies, which included 575 pCAPs from 701 patients, were finally analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratios of LU were 96.7%, 87.3%, 8.10, 0.05, 256.68, while they were 89.7%, 93.7%, 9.97, 0.12, 175.07 for CR, respectively. The area under the SROC curves in diagnosing pCAP in the ED setting were 0.99 [95% confidence interval (CI), 0.98-1.00] and 0.97 (95% CI, 0.95-1.00) for LU and CR, respectively.
Our meta-analysis suggests that LU is an accurate tool in the diagnosis of pCAP in the ED setting with a superior sensitivity over CR.
儿童社区获得性肺炎（pCAP）是一个重大的公共卫生和经济问题，对儿童的发病率和死亡率有相当大的影响。最近，许多研究和荟萃分析表明，肺部超声检查（LU）在诊断肺炎方面的准确性很有前景，并且有可能在儿科人群中取代胸部X线摄影（CR）。然而，以往确定LU准确性的研究通常将CR用作参考标准，并综合考虑了不同的临床情况。为了进行更客观和具体的分析，我们进行了一项系统评价和荟萃分析，以比较在急诊科（ED）环境中LU和CR对pCAP的诊断准确性。
对截至2018年12月的PubMed和Embase数据库进行文献检索。计算LU和CR的合并敏感性、特异性、阳性和阴性似然比以及诊断比值比，并绘制汇总受试者工作特征（SROC）曲线。
最终分析了6项研究，包括来自701例患者的575例pCAP。LU的合并敏感性、特异性、阳性似然比、阴性似然比和诊断比值比分别为96.7%、87.3%、8.10、0.05、256.68，而CR的分别为89.7%、93.7%、9.97、0.12、175.07。在急诊科环境中诊断pCAP时，LU和CR的SROC曲线下面积分别为0.99 [95%置信区间（CI），0.98 - 1.00]和0.97（95%CI，0.95 - 1.00）。
我们的荟萃分析表明，LU是急诊科环境中诊断pCAP的准确工具，其敏感性优于CR。
