Accuracy of lung ultrasound and chest X-rays in diagnosing acute pulmonary oedema in patients presenting with acute dyspnoea in emergency department

2021 ◽  
Vol 71 (10) ◽  
pp. 2423-2425
Author(s):  
Sanniya Khan Ghauri ◽  
Khawaja Junaid Mustafa ◽  
Arslaan Javaeed ◽  
Abdus Salam Khan
Keyword(s):  
Emergency Department ◽  
Lung Ultrasound ◽  
Acute Pulmonary Oedema ◽  
X Rays ◽  
Acute Dyspnea ◽  
Inclusion Criteria ◽  
Predictive Values ◽  
X Ray ◽  
Acute Dyspnoea ◽  
Chest X Ray

To determine the diagnostic accuracy of lung ultrasound and chest X-ray in diagnosing Acute Pulmonary Edema (APE) in patients presenting with acute dyspnea in emergency department. This study was conducted at the emergency department of Shifa International Hospital, Islamabad from 31st July 2018 to 31st January 2019. A total of 225 patients presenting with dyspnoea and satisfying inclusion criteria were assessed by clinical examination, lung USG and chest X-ray. The results of chest X-ray and lung USG were compared with clinical diagnosis. The current study revealed sensitivity of chest X-ray and LUS ( 60.16% versus 91.05%), specificity (66.67% versus 91.18%), positive predictive value  (68.52% versus 92.56%) and the negative predictive values (58.12% versus 89.42%) respectively. Present study revealed that the LUS has better accuracy than chest X-ray for diagnosis of APE. Continuou...

scholarly journals The influence of chest X-ray results on antibiotic prescription for childhood pneumonia in the emergency department

2021 ◽  
Author(s):  
Josephine S. van de Maat ◽  
Daniella Garcia Perez ◽  
Gertjan J. A. Driessen ◽  
Anne-Marie van Wermeskerken ◽  
Frank J. Smit ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Treatment Decisions ◽  
X Rays ◽  
X Ray ◽  
Chest X Ray ◽  
Tract Infections

AbstractThe aim of this study is to evaluate the influence of chest X-ray (CXR) results on antibiotic prescription in children suspected of lower respiratory tract infections (RTI) in the emergency department (ED). We performed a secondary analysis of a stepped-wedge, cluster randomized trial of children aged 1 month to 5 years with fever and cough/dyspnoea in 8 EDs in the Netherlands (2016–2018), including a 1-week follow-up. We analysed the observational data of the pre-intervention period, using multivariable logistic regression to evaluate the influence of CXR result on antibiotic prescription. We included 597 children (median age 17 months [IQR 9–30, 61% male). CXR was performed in 109/597 (18%) of children (range across hospitals 9 to 50%); 52/109 (48%) showed focal infiltrates. Children who underwent CXR were more likely to receive antibiotics, also when adjusted for clinical signs and symptoms, hospital and CXR result (OR 7.25 [95% CI 2.48–21.2]). Abnormalities on CXR were not significantly associated with antibiotic prescription.Conclusion: Performance of CXR was independently associated with more antibiotic prescription, regardless of its results. The limited influence of CXR results on antibiotic prescription highlights the inferior role of CXR on treatment decisions for suspected lower RTI in the ED. What is Known:• Chest X-ray (CXR) has a high inter-observer variability and cannot distinguish between bacterial or viral pneumonia.• Current guidelines recommend against routine use of CXR in children with uncomplicated respiratory tract infections (RTIs) in the outpatient setting. What is New:• CXR is still frequently performed in non-complex children suspected of lower RTIs in the emergency department• CXR performance was independently associated with more antibiotic prescriptions, regardless of its results, highlighting the inferior role of chest X-rays in treatment decisions.

scholarly journals Lung Ultrasound in COVID-19 pandemic: Why? How? And When?

2020 ◽  
pp. 3-12
Author(s):  
Khrystyna Pronyuk ◽  
Andriy Vysotskyi
Keyword(s):  
Critically Ill ◽  
Computer Tomography ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Clinical Decision ◽  
X Rays ◽  
Lung Involvement ◽  
X Ray ◽  
Chest X Ray

During COVID-19 pandemic Lung ultrasound has rapidly become a tool for diagnosis and monitoring of lung involvement and it’s severity. Accurate evaluation of lung pathologic entities at the bedside, especially in critically ill patients, and those on mechanical ventilation, remains problematic. CT should not be frequently repeated and is not available everywhere, especially for critically ill patients. Limitations of bedside chest X-ray have been well described and lead to poor-quality X-ray films with low sensitivity.The lung ultrasound has been shown to be a useful tool in intensive care patients with adult respiratory distress syndrome (ARDS) and can be used forassessing severity of lung involvement in COVID-19. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. There have been shown that lung ultrasound can predict the deterioration of the patient's conditionand can be used for risk stratification and clinical decision making, reducethe use of both chest x‐rays and computer tomography, what is very important especially in limited resources settings.

scholarly journals Implementing Lung Ultrasound in the Outpatient Management of COVID-19 Pneumonia: A Pilot Study to Update Local Guidelines

2021 ◽  
Vol 8 ◽  
Author(s):  
Chloé Chevallier Lugon ◽  
Aileen Kharat ◽  
Paola M. Soccal ◽  
Idris Guessous ◽  
Hervé Spechbach ◽  
...  
Keyword(s):  
Systematic Approach ◽  
Lung Ultrasound ◽  
High Sensitivity ◽  
Descriptive Statistics ◽  
X Rays ◽  
Single Center ◽  
X Ray ◽  
Ambulatory Patients ◽  
Chest X Ray

Background: Lung ultrasound (LUS) has a good performance with a high sensitivity and specificity for the diagnosis of pneumonia compared with chest X-ray, and it has been extensively used to assess patients during the COVID-19 pandemic. This study aims to evaluate the potential advantages of the regular use of LUS for the assessment of the severity and prognosis of COVID-19 pneumonia and to propose an adapted protocol with its inclusion in current local validated and published guidelines.Methods: This is a single-center prospective study conducted during the first (April–May 2020) and second (October 2020–January 2021) waves of the SARS-CoV2 pandemic in Switzerland. All adult patients presenting to dedicated test centers with a suspicion of mild-to-moderate COVID-19 pneumonia and not requiring hospitalization at the time of diagnosis were included. Patients with confirmed COVID-19 pneumonia were referred to an ambulatory follow-up unit at our institution for reassessment, with the inclusion of the use of LUS in a random selection. Descriptive statistics were calculated for demographics using percentages, means, and standard deviations according to the distribution of variables.Results: Eighty-eight ambulatory patients with a confirmed COVID-19 pneumonia were included (men = 57 [59%]; mean age, 52.1 ± 13.5 years). Among these, 19 (21%) were hospitalized and none died. Twenty-five lung assessments by ultrasound were performed during the follow-up consultation. All were consistent with the clinical examination and confirmed the clinician's opinion.Conclusion: The use of a standardized pleuro-pulmonary ultrasound protocol for ambulatory patients with COVID-19 could help to reduce the use of chest X-rays and improve overall management at the time of referral and eventual follow-up. However, a specific study including LUS in a systematic approach should be performed to evaluate the outcome of patients according to findings.

scholarly journals Sensitivity of chest ultrasound for postoperative pneumothorax in comparison to chest X-ray after lung resecting surgery

2019 ◽  
Vol 57 (5) ◽  
pp. 846-853
Author(s):  
Thomas Galetin ◽  
Jérôme Defosse ◽  
Mark Schieren ◽  
Ben Marks ◽  
Alberto Lopez-Pastorini ◽  
...  
Keyword(s):  
Patient Selection ◽  
Chest Tube ◽  
X Rays ◽  
Medical Patients ◽  
Clinical Trial Registration ◽  
Predictive Values ◽  
Thoracic Ultrasound ◽  
X Ray ◽  
Therapeutic Decisions ◽  
Chest X Ray

Abstract OBJECTIVES Thoracic ultrasound is superior to chest X-ray for the detection of a pneumothorax in trauma and intensive care medicine. Data regarding its use in non-cardiac thoracic surgery are scarce and contradictory. Previous studies are heterogeneous regarding sonographic methodology and patient selection. This study aimed to evaluate the accuracy of thoracic ultrasound for pneumothorax assessment after lung resecting surgery in unselected patients. METHODS SONOR (SONOgraphy vs x-Ray) is a prospective observational trial (registry-ID DRKS00014557). A total of 123 consecutive patients with lung resecting surgery received a standardized thoracic ultrasound the same day and in addition to routine chest X-rays in erect position after removal of the chest tube. The sonographer was blinded to radiological findings and vice versa. RESULTS Sensitivity, specificity, positive and negative predictive values of ultrasound after removing the chest tube were 0.32, 0.85, 0.54, 0.69 for any pneumothorax and 1.0, 0.82, 0.19, 1.0 for pneumothorax ≥3 cm. No clinically relevant pneumothorax was missed. The agreement between sonography- and routine-based therapeutic decisions was 97%. Lung pulse was the most frequently detected sign to sonographically rule out a pneumothorax. CONCLUSIONS Postoperative thoracic ultrasound in unselected patients has a low overall sensitivity to detect a residual pneumothorax; however, its sensitivity and negative predictive values regarding clinically relevant pneumothorax are high. Test quality depends on the distinct sonographic methodology and patient selection. Anatomic differences in postsurgical and medical patients may be responsible for the contradictory results of previous trials. Studies with a larger population size are required to validate the accuracy of relevant pneumothoraces and identify appropriate selection criteria. Clinical trial registration number DRKS—German Clinical Trials Register, www.drks.de, registry-ID DRKS00014557.

The Diagnostic Role of Lung Ultrasound in Critically Ill Patients In Comparison With Chest X-Ray

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mina Fayez Hanna ◽  
Fahmy Saad Latef ◽  
Ahmed Mohamed El-Sayed El-Hennawy ◽  
Wessam Zaher Selima
Keyword(s):  
Pleural Effusion ◽  
Critically Ill ◽  
Sensitivity And Specificity ◽  
Critically Ill Patients ◽  
Lung Ultrasound ◽  
Low Cost ◽  
Acute Dyspnea ◽  
X Ray ◽  
Pleural Diseases ◽  
Chest X Ray

Abstract Purpose To compare between lung ultrasound and chest X-ray in diagnosis of different lung pathologies in critically ill patients using lung CT as a gold standard. Methods Comparative prospective randomized single group observational study was conducted in the Critical Care unit (medical and surgical ICU). The study was conducted upon fifty patients (28 females &22 males) with a mean age of 58 years (SD ± 15.55; (19 - 82) presented to Kom Hamadah Hospital during a period of one year starting from July 2018 to July 2019, with acute dyspnea as the primary complaint or developed acute dyspnea and or tachypnea during their ICU stay were evaluated for the presence of pleural effusion, pneumothorax, alveolar-Interstitial Pathology and consolidation by LUS and CXR for detecting the sensitivity and specificity of each modality with CT chest done as a reference in cases of doubt. Results The comparison between Sensitivity and Specificity of US finding was (86.8% for parenchymal disease, 100.0% for pleural diseases) and (100.0% for parenchymal diseases, 94.7% for pleural diseases) respectively while CXR finding was (65.8% for parenchymal diseases, 75.0% for pleural diseases) and (58.3% for parenchymal diseases), (92.1% for pleural diseases) respectively among studied patients. Conclusion Transthoracic ultrasound is valuable for the evaluation of a wide variety of chest diseases, particularly mechanically ventilated patient. The advantages of low cost, bedside availability and no radiation exposure have made ultrasound an indispensable diagnostic tool in ICU. Lung ultrasound is more sensitive than chest x-ray in diagnosis and follow up chest diseases) PNX, alveolar-interstitial syndromes, parenchymal consolidations, and pleural effusion (LUS is an interesting medical method that is complementary to bedside CXR and reduces the need to use a CT scan.

scholarly journals Role of peak expiratory flow rate and chest radiography in children above 5 years of age with acute asthma

2020 ◽  
Vol 7 (2) ◽  
pp. 372
Author(s):  
Sankeerthana Shankarnarayana ◽  
Jaidev M. Devdas ◽  
Sujonitha John ◽  
Habeeb Ullah Khan ◽  
Pavan Hegde
Keyword(s):  
Emergency Department ◽  
Oxygen Saturation ◽  
Standard Treatment ◽  
Acute Asthma ◽  
X Rays ◽  
Bronchodilator Therapy ◽  
X Ray ◽  
Before And After ◽  
Chest X Ray

Background: Asthma is a heterogeneous disease characterized by cough, wheeze and shortness of breath that vary in intensity and time with variable expiratory airflow limitation, associated with chronic airway inflammation. Aim of the study was to assess the usefulness of Peak Expiratory Flow Rate [PEFR] and oxygen saturation in determining severity of acute asthma, to measure objective change in PEFR and oxygen saturation following bronchodilator therapy and the role of chest X-rays in acute asthma.Methods: A prospective study of 50 children above 5 years with acute asthma who presented to the emergency department in a tertiary care hospital were included. PEFR and oxygen saturation before and after bronchodilator therapy was measured. Indication for chest X-rays, its clinical correlation and change in standard treatment of acute asthma based on X-ray reports was noted.Results: The mean PEFR and PEFR % of expected was lower in severe asthma when compared to moderate asthma and was statistically significant (p<0.001). The % of expected PEFR before salbutamol therapy was 48.78±14.36, which improved significantly to 67.13±14.22 after treatment (p<0.001). Oxygen saturation before and after salbutamol therapy was 94.96 ± 4.11 and 96.96±2.87 respectively with the change being significant (p value <0.001). Chest X-rays were performed in 12 (24%) children as per standard guidelines, of which 1(9%) was abnormal showing right basal consolidation. Chest X-ray correlated with clinical findings in 1 child and the findings on chest X-ray altered the ongoing treatment by addition of antibiotic.Conclusions: PEFR and oxygen saturation is useful in the emergency department to objectively assess the severity of acute asthma and the response to initial bronchodilator therapy. Chest X-rays are not routinely indicated in the standard treatment of acute asthma.

scholarly journals Lung Ultrasonography and Chest Radiography in Suspected Cases of Pneumonia in Critically Ill Patients- A Comparative Study

2020 ◽  
Vol 8 (2) ◽  
pp. 88-90
Author(s):  
Bharat M.P ◽  
Deepak K.S
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Chest Radiography ◽  
Lung Ultrasound ◽  
Age Group ◽  
Lung Ultrasonography ◽  
Predictive Values ◽  
X Ray ◽  
Chest X Ray ◽  
The Difference

Background: The present study compared lung ultrasound (USG) and chest radiography in suspected cases of pneumonia in critically ill patients. Subjects & Methods: 56 patients age above 20 years of age of both genders diagnosed with pneumonia were included. Patients were subjected to chest USG and X ray. Positive predictive values for both lung ultrasound and chest X-ray were calculated. Results: Age group 20-30 years had 4 patients, 30-40 years had 6, 40-50years had 10, 50-60 years had 16 and >60 years had 20 patients. The difference was significant (P< 0.05). Chest x ray reveled 40 out of 56 cases positive and 16 negative and USH showed 52 positive and 4 negative. Positive predictive value (PPV) of chest x- ray was 71.4% and USG was 92.8%. The difference was significant (P< 0.05). Conclusion: Lung ultrasound is an effective radiological tool for the assessment of suspected cases of pneumonia as compared to chest x ray.

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