Pulmonary ultrasound versus chest radiography in the diagnosis of community-acquired pneumonia in adults: an updated systematic review and meta-analysis
Abstract
INTRODUCTION
Although chest radiography (CXR) has traditionally been used as the initial diagnostic test, pulmonary ultrasound (US) has emerged in recent years as a radiation-free, portable, and potentially more sensitive and specific alternative.
OBJECTIVE
To evaluate the diagnostic accuracy of US compared to CXR for detecting community-acquired pneumonia (CAP) in adults through a systematic review and meta-analysis.
METHODOLOGY
Comprehensive searches were conducted in SCOPUS, Web of Science, PubMed, and EMBASE databases. Observational studies comparing US with CXR in diagnosing CAP were included, using computed tomography as the reference standard for all patients. Random-effect models were used for statistical analysis, calculating sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratios (DOR). Meta-regression analyses were performed, and SROC curves were constructed to compare diagnostic performance.
RESULTS
Eight studies using CT as a reference standard were included. US showed superior performance with sensitivity 90.0 % (95 % CI: 81.3-96.2 %), specificity 90.8 % (95 % CI: 79.9-97.7 %), LR+ 9.45 (95 % CI: 3.73-23.94), LR- 0.12 (95 % CI: 0.06-0.24), and DOR 79.74. CXR demonstrated lower values with sensitivity 72.6 % (95 % CI: 61.7-82.4 %), specificity 82.0 % (95 % CI: 65.5-93.9 %), LR+ 3.98 (95 % CI: 1.87-8.49), LR- 0.36 (95 % CI: 0.23-0.54), and DOR 11.17. Both modalities showed significant heterogeneity, which was not explained by the sample size…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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