Chest
Volume 140, Issue 4, October 2011, Pages 859-866
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Original Research
Pulmonary Procedures
Diagnosis of Pneumothorax by Radiography and Ultrasonography: A Meta-analysis

https://doi.org/10.1378/chest.10-2946Get rights and content

Objective

This study compares, by meta-analysis, the use of anterior-posterior chest radiography (CR) with transthoracic ultrasonography for the diagnosis of pneumothorax.

Methods

English-language articles on the performance of CR and ultrasonography in the diagnosis of a pneumothorax were selected. In eligible studies, data were recalculated, and the forest plots and summary receiver operating characteristic (sROC) curves were analyzed.

Results

Pooled sensitivity and specificity were 0.88 and 0.99, respectively, for ultrasonography, and 0.52 and 1.00, respectively, for CR. For ultrasonography performed by clinicians other than radiologists, pooled sensitivity and specificity were 0.89 and 0.99, respectively. The sROC areas under the curve were compared, and no significant differences between ultrasonography and CR were found. Meta-regression analysis implied that the operator is strongly associated with accuracy (relative diagnostic OR, 0.21; 95% CI, 0.05-0.96; P = .0455).

Conclusions

The meta-analysis indicated that bedside ultrasonography performed by clinicians had higher sensitivity and similar specificity compared with CR in the diagnosis of pneumothorax, but the accuracy of ultrasonography in the diagnosis of pneumothorax depended on the skill of the operators.

Section snippets

Study Design and Data Sources

A literature review and meta-analysis were conducted. Original articles published in English up to the end of October 2010 were searched in Medline, EMBASE, and the Cochrane Library. We used combinations of the following key words to identify all original articles in which ultrasonography, CR, or both were used in diagnosing PNX: (“ultrasound” or “sonography” or “ultrasonography” or “radiography” or “chest film” or “chest radiograph”) and (“pneumothorax” or “aerothorax” or “aeropleura”) and

Results

From the literature search, we retrieved 20 English-language articles eligible for analysis. The characteristics of the eligible articles are shown in Table 1.

The details of the quality assessment are shown in e-Table 1. The eligible studies achieved most of the quality items. All 20 studies passed QUADAS items 2, 3, 8, and 9. The sample of 17 studies (85%) achieved verification using the standard of diagnosis (item 5). QUADAS item 6 (patients received the same reference standard regardless of

Discussion

The results of the present study demonstrat superior sensitivity and similar specificity in the use of ultrasonography compared with CR for the diagnosis of PNX. Using sROC curves derived from the available published articles, we conclude that bedside ultrasonography performed by clinicians other than radiologists is as accurate as CR in detecting PNX. Although there was no statistical significance, it seemed to be more accurate for the diagnosis of PNX when both the lung sliding sign and the

Conclusions

Clinician-performed ultrasonography is a reliable tool in the diagnosis of PNX. It has the advantage of portability, simplicity, rapidity, and higher sensitivity and similar specificity compared with CR. Ultrasonography provides a useful adjunct for clinicians in treating patients with multiple trauma or who are ventilated, but the accuracy of ultrasonography in the diagnosis of PNX depends on the skill of the operators.

Acknowledgments

Author contributions: Dr Ding had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Ding: contributed to the study design; data collection, analysis, and interpretation; preparation of the manuscript; and review and approval of the final manuscript.

Dr Shen: contributed to the data collection, analysis, and interpretation; preparation of the manuscript; and review and approval of the final manuscript.

Dr

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    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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