与胸部X光相比，床边肺部超声作为诊断肺炎的独立工具：一项来自重症监护病房的前瞻性观察研究。
Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units.
作者信息
Dhawan Jonny, Singh Gurpreet
机构信息
DNB Critical Care Medicine Resident, SPS Hospitals, Ludhiana, Punjab, India.
Department of Critical Care Medicine, SPS Hospitals, Ludhiana, Punjab, India.
出版信息
Indian J Crit Care Med. 2022 Aug;26(8):920-929. doi: 10.5005/jp-journals-10071-24283.
BACKGROUND
Diagnosing pneumonia is challenging because of multiple differential diagnosis. Bedside lung ultrasound (BLUS) is a safe, portable, rapid and inexpensive new modality to diagnose pneumonia. This study was aimed to evaluate the sensitivity of BLUS vs chest X-ray (CXR) to diagnose community-acquired pneumonia (CAP) using computed tomography (CT) scans as the gold standard.
PATIENTS AND METHODS
An observational cross-sectional study was conducted in selected intensive care units (ICUs). Eligible 85 adult patients with symptoms suggestive of pneumonia as per 2007 Infectious Disease Society of America (IDSA), American Thoracic Society (ATS) criteria, and 2D echocardiography were enrolled consecutively by using convenient sampling technique. Real-time reverse transcription-polymerase chain reaction (RT-PCR) assay for SARS-associated coronavirus was sent with in 1 hour followed by BLUS and CXR within 24 hours of ICU admission. The final confirmation of CAP was done by a thoracic CT scan.
RESULTS
Bedside lung ultrasound vs CXR could detect 74 vs 58 cases out of 84 confirmed cases. Sensitivity and specificity of BLUS vs CXR was 88.1% vs 67.8% and 100% vs 0%, respectively. Moreover, LR+ and LR- for BLUS was found to be 0 and 0.12 in comparison to 0.68 and 0 for CXR. The area under receiver operator characteristics (ROC) curve for BLUS vs CXR was 0.94 (95% CI 0.0-1.0) with = 0.13 and 0.66 (95% CI 0.12-1.0) with = 0.58. There was a significant agreement between diagnostic accuracy of BLUS and CT scan [kappa value (κ) = 0.14, = 0.009], whereas CXR could not establish its diagnostic efficiency (κ = -0.023, = 0.493). Sonographic features of pneumonia were B-lines, shred, and hepatization signs.
CONCLUSION
It is observed that BLUS showed higher sensitivity, specificity, and diagnostic accuracy as compared to CXR to diagnose pneumonia.
HOW TO CITE THIS ARTICLE
Dhawan J, Singh G. Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units. Indian J Crit Care Med 2022;26(8):920-929.
背景
由于存在多种鉴别诊断，肺炎的诊断具有挑战性。床旁肺部超声（BLUS）是一种安全、便携、快速且经济的肺炎诊断新方法。本研究旨在以计算机断层扫描（CT）作为金标准，评估BLUS与胸部X线（CXR）诊断社区获得性肺炎（CAP）的敏感性。
患者与方法
在选定的重症监护病房（ICU）进行了一项观察性横断面研究。根据2007年美国传染病学会（IDSA）、美国胸科学会（ATS）标准以及二维超声心动图，采用方便抽样技术连续纳入85例有肺炎症状的成年患者。在1小时内送检严重急性呼吸综合征相关冠状病毒的实时逆转录聚合酶链反应（RT-PCR）检测，随后在入住ICU后24小时内进行BLUS和CXR检查。CAP的最终确诊通过胸部CT扫描完成。
结果
在84例确诊病例中，床旁肺部超声与CXR分别检测出74例和58例。BLUS与CXR的敏感性和特异性分别为88.1%对67.8%以及100%对0%。此外，与CXR的阳性似然比（LR+）为0.68、阴性似然比（LR-）为0相比，BLUS的LR+为0、LR-为0.12。BLUS与CXR的受试者操作特征（ROC）曲线下面积分别为0.94（95%可信区间0.0 - 1.0），P值 = 0.13，以及0.66（95%可信区间0.12 - 1.0），P值 = 0.58。BLUS与CT扫描的诊断准确性之间存在显著一致性[kappa值（κ） = 0.14，P值 = 0.009]，而CXR未能确立其诊断效率（κ = -0.023，P值 = 0.493）。肺炎的超声特征为B线、碎片征和肝样变征。
结论
观察发现，与CXR相比，BLUS在诊断肺炎方面具有更高的敏感性、特异性和诊断准确性。
如何引用本文
Dhawan J, Singh G. Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units. Indian J Crit Care Med 2022;26(8):920 - 929.
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