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Emerg Med J 29:19-23 doi:10.1136/emj.2010.101584
  • Original article

Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department

  1. Pier Giorgio Duca2
  1. 1Emergency Department, Niguarda Hospital, Milan, Italy
  2. 2Institute of Biometrics and Medical Statistics, L. Sacco Hospital, University of Milan, Milan, Italy
  1. Correspondence to Dr Francesca Cortellaro, S.C. Medicina d'Urgenza e Pronto Soccorso, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, Milano, Italy; francesca_cortellaro{at}fastwebnet.it
  • Accepted 22 September 2010
  • Published Online First 28 October 2010

Abstract

Objective The aim of this study was to evaluate the diagnostic accuracy of bedside lung ultrasound and chest radiography (CXR) in patients with suspected pneumonia compared with CT scan and final diagnosis at discharge.

Design A prospective clinical study.

Methods Lung ultrasound and CXR were performed in sequence in adult patients admitted to the emergency department (ED) for suspected pneumonia. A chest CT scan was performed during hospital stay when clinically indicated.

Results 120 patients entered the study. A discharge diagnosis of pneumonia was confirmed in 81 (67.5%). The first CXR was positive in 54/81 patients (sensitivity 67%; 95% CI 56.4% to 76.9%) and negative in 33/39 (specificity 85%; 95% CI 73.3% to 95.9%), whereas lung ultrasound was positive in 80/81 (sensitivity 98%; 95% CI 93.3% to 99.9%) and negative in 37/39 (specificity 95%; 95% CI 82.7% to 99.4%). A CT scan was performed in 30 patients (26 of which were positive for pneumonia); in this subgroup the first CXR was diagnostic for pneumonia in 18/26 cases (sensitivity 69%), whereas ultrasound was positive in 25/26 (sensitivity 96%). The feasibility of ultrasound was 100% and the examination was always performed in less than 5 min.

Conclusions Bedside chest ultrasound is a reliable tool for the diagnosis of pneumonia in the ED, probably being superior to CXR in this setting. It is likely that its wider use will allow a faster diagnosis, conducive to a more appropriate and timely therapy.

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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