Chest
Original ResearchChest InfectionsLung Ultrasound in the Diagnosis and Follow-up of Community-Acquired Pneumonia: A Prospective, Multicenter, Diagnostic Accuracy Study
Section snippets
Materials and Methods
This was an international, multicenter, prospective, observational study in patients with suspected CAP in 14 European centers (two university hospitals, seven hospitals of internal medicine, one hospital of pulmonary medicine, two practices, and two EDs). The institutional review board approved the study protocol (number 2055-06/07), and patients provided written, informed consent before enrollment. This study is reported according to the Standards for the Reporting of Diagnostic Accuracy
Results
Between November 2007 and February 2011, 14 European centers recruited 397 patients. Thirty-five patients were excluded because of violations of inclusion criteria (n = 3) or an equivocal reference test (n = 32) (Fig 1). The remaining 362 patients underwent LUS and radiographic examinations. Sixty-three patients (17.4%) had low-dose CT scans; of them, 46 were according to the study protocol. In the remaining 17 patients, radiographic findings were confirmed by a spiral CT scan, which was
Discussion
To our knowledge, this is the first prospective multicenter study dealing with the use of LUS in the diagnosis and follow-up of CAP. These results show an excellent sensitivity of 94% and specificity of 98%, comparable with chest radiograph in two planes. LR > 10 and < 0.01 are considered to rule in or rule out diagnosis in most circumstances.12 Combining typical auscultation and positive LUS findings was about 43 times more likely in patients with CAP and provides strong evidence to rule in
Conclusions
To our knowledge, this is the first multicenter feasibility study to demonstrate that CAP may be diagnosed and followed up with LUS. The results show an excellent sensitivity and specificity at least comparable with chest radiograph in two planes. In cases with sonographic evidence of pneumonia, the diagnosis can be established. A radiograph or CT scan of the chest is necessary in cases with negative ultrasound results (in about 8% of the patients), if other differential diagnoses are taken
Acknowledgments
Author contributions: Dr Reissig had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Reissig: contributed to the study conception and design, analysis and interpretation of the data, drafting of the manuscript and critical revision for important intellectual content, and approval of the final manuscript to be published.
Dr Copetti: contributed to the study conception and design, analysis and
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.