Maurizio Zanobetti1, Claudio Poggioni2, Riccardo Pini2. 1. Department of Critical Care Medicine and Surgery, University of Florence, and Intensive Observation Unit, Careggi University Hospital, Florence, Italy. Electronic address: zanomau@libero.it. 2. Department of Critical Care Medicine and Surgery, University of Florence, and Intensive Observation Unit, Careggi University Hospital, Florence, Italy.
Abstract
BACKGROUND: We examined the concordance between chest ultrasonography and chest radiography in patients with dyspnea, using chest CT scanning as the gold standard in case of mismatch between the two modalities. METHODS: A prospective, blinded, observational study was conducted in the ED of a university-affiliated teaching hospital. All consecutive patients presenting for dyspnea during a single emergency physician shift were enrolled independently from the underlying disease. Only patients with trauma were excluded. RESULTS: Both ultrasonography and radiography were performed in 404 patients; CT scanning was performed in 118 patients. Ultrasound interpretation was completed during the scan, whereas the average time between radiograph request and its final interpretation was 1 h and 35 min. Ultrasonography and radiography exhibited high concordance in most pulmonary diseases, especially in pulmonary edema (κ = 95%). For lung abnormalities such as free pleural effusion, loculated pleural effusion, pneumothorax, and lung consolidation, the concordance was similar for both left- and right-side lungs (all P not significant). When ultrasound scans and radiographs gave discordant results, CT scans confirmed the ultrasound findings in 63% of patients (P < .0001). Particularly, ultrasonography exhibited greater sensitivity than radiography in patients with free pleural effusion (P < .0001). CONCLUSIONS: When performed by one highly trained physician, our study demonstrated high concordance between ultrasonography and radiography. When ultrasound scans and radiographs disagreed, ultrasonography proved to be more accurate in distinguishing free pleural effusion. Thus, considering the short time needed to have a final ultrasound report, this technique could become the routine imaging modality for patients with dyspnea presenting to the ED.
BACKGROUND: We examined the concordance between chest ultrasonography and chest radiography in patients with dyspnea, using chest CT scanning as the gold standard in case of mismatch between the two modalities. METHODS: A prospective, blinded, observational study was conducted in the ED of a university-affiliated teaching hospital. All consecutive patients presenting for dyspnea during a single emergency physician shift were enrolled independently from the underlying disease. Only patients with trauma were excluded. RESULTS: Both ultrasonography and radiography were performed in 404 patients; CT scanning was performed in 118 patients. Ultrasound interpretation was completed during the scan, whereas the average time between radiograph request and its final interpretation was 1 h and 35 min. Ultrasonography and radiography exhibited high concordance in most pulmonary diseases, especially in pulmonary edema (κ = 95%). For lung abnormalities such as free pleural effusion, loculated pleural effusion, pneumothorax, and lung consolidation, the concordance was similar for both left- and right-side lungs (all P not significant). When ultrasound scans and radiographs gave discordant results, CT scans confirmed the ultrasound findings in 63% of patients (P < .0001). Particularly, ultrasonography exhibited greater sensitivity than radiography in patients with free pleural effusion (P < .0001). CONCLUSIONS: When performed by one highly trained physician, our study demonstrated high concordance between ultrasonography and radiography. When ultrasound scans and radiographs disagreed, ultrasonography proved to be more accurate in distinguishing free pleural effusion. Thus, considering the short time needed to have a final ultrasound report, this technique could become the routine imaging modality for patients with dyspnea presenting to the ED.
Authors: Giovanni Volpicelli; Mahmoud Elbarbary; Michael Blaivas; Daniel A Lichtenstein; Gebhard Mathis; Andrew W Kirkpatrick; Lawrence Melniker; Luna Gargani; Vicki E Noble; Gabriele Via; Anthony Dean; James W Tsung; Gino Soldati; Roberto Copetti; Belaid Bouhemad; Angelika Reissig; Eustachio Agricola; Jean-Jacques Rouby; Charlotte Arbelot; Andrew Liteplo; Ashot Sargsyan; Fernando Silva; Richard Hoppmann; Raoul Breitkreutz; Armin Seibel; Luca Neri; Enrico Storti; Tomislav Petrovic Journal: Intensive Care Med Date: 2012-03-06 Impact factor: 17.440
Authors: P H Mayo; R Copetti; D Feller-Kopman; G Mathis; E Maury; S Mongodi; F Mojoli; G Volpicelli; M Zanobetti Journal: Intensive Care Med Date: 2019-08-15 Impact factor: 17.440
Authors: Biagio Liccardo; Francesca Martone; Paolo Trambaiolo; Sergio Severino; Gian Alfonso Cibinel; Antonello D'Andrea Journal: World J Radiol Date: 2016-05-28
Authors: Moritz Lindner; Richard Thomas; Brian Claggett; Eldrin F Lewis; John Groarke; Allison A Merz; Montane B Silverman; Varsha Swamy; Jose Rivero; Christian Hohenstein; Scott D Solomon; John Jv McMurray; Michael L Steigner; Elke Platz Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-01-24