Comparing accuracy of bedside ultrasound examination with physical examination for detection of pleural effusion

The Ultrasound Journal

Leo M. Smyth¹  Christopher J. Oleynick²  Michael H. Walsh²  Irene W. Y. Ma³  Nicholas G. Cowley⁴  Kang X. Zhang⁴  Justin M. Chen⁴  Emily J. Cox⁵ 

[1] Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada;Division of General Internal Medicine, University of Calgary, Calgary, AB, Canada;Division of General Internal Medicine, University of Calgary, Calgary, AB, Canada;Department of Medicine, W21C, University of Calgary, 3330 Hospital Dr NW, T2N 4N1, Calgary, AB, Canada;Department of Community Health Sciences, W21C, University of Calgary, Calgary, AB, Canada;Providence Health Care, Providence Internal Medicine Residency Spokane, Spokane, WA, USA;Providence Health Care, Providence Medical Research Center, Spokane, WA, USA;

关键词: Ultrasound;    Point-of-care ultrasound;    Pleural effusion;    Physical examination;   

DOI  :  10.1186/s13089-021-00241-7

来源: Springer

【 摘 要 】

BackgroundIn detecting pleural effusion, bedside ultrasound (US) has been shown to be more accurate than auscultation. However, US has not been previously compared to the comprehensive physical examination. This study seeks to compare the accuracy of physical examination with bedside US in detecting pleural effusion.MethodsThis study included a convenience sample of 34 medical inpatients from Calgary, Canada and Spokane, USA, with chest imaging performed within 24 h of recruitment. Imaging results served as the reference standard for pleural effusion. All patients underwent a comprehensive lung physical examination and a bedside US examination by two researchers blinded to the imaging results.ResultsPhysical examination was less accurate than US (sensitivity of 44.0% [95% confidence interval (CI) 30.0–58.8%], specificity 88.9% (95% CI 65.3–98.6%), positive likelihood (LR) 3.96 (95% CI 1.03–15.18), negative LR 0.63 (95% CI 0.47–0.85) for physical examination; sensitivity 98% (95% CI 89.4–100%), specificity 94.4% (95% CI 72.7–99.9%), positive LR 17.6 (95% CI 2.6–118.6), negative LR 0.02 (95% CI 0.00–0.15) for US). The percentage of examinations rated with a confidence level of 4 or higher (out of 5) was higher for US (85% of the seated US examination and 94% of the supine US examination, compared to 35% of the PE, P < 0.001), and took less time to perform (P < 0.0001).ConclusionsUS examination for pleural effusion was more accurate than the physical examination, conferred higher confidence, and required less time to complete.

【 授权许可】

CC BY