Chest
Original ResearchPulmonary ProceduresTest Characteristics of Ultrasonography for the Detection of Pneumothorax: A Systematic Review and Meta-analysis
Section snippets
Study Design, Subjects, and Interventions
We systematically reviewed the literature for prospective studies in which chest ultrasonography was used for diagnosis in patients with clinically suspected pneumothorax of any cause. We included studies in which the reference standard used was either CT scan findings or release of air on chest tube insertion. We excluded studies on the pediatric population.
Outcome Measures and Search Strategy
Our main outcome measure was to determine the sensitivity, specificity, negative predictive value (NPV), and positive predictive value
Characteristics of Selected Studies
We completed our initial search strategy in December 2009 and identified 570 potential articles. We did not identify any unpublished studies; our electronic search strategy identified all potential studies. We repeated our electronic search on November 30, 2010 and did not identify any additional published studies since our initial query. Based on manuscript titles and abstracts, we excluded 549 papers (κ, 0.89). After reviewing the full text of 21 studies that were potentially eligible for
Discussion
In this systematic review and meta-analysis, we found that the performance of ultrasonography for the detection of pneumothorax is excellent. Ultrasonography is more sensitive than chest radiography for the detection of pneumothorax by a clinically and statistically significant margin. The performance of ultrasonography was consistent when pneumothoraces were caused by trauma or invasive procedures.
Although still performing better than chest radiography, ultrasonography sensitivity was low in
Conclusions
This study demonstrates that chest ultrasonography can help recognize pneumothoraces with a sensitivity significantly superior and a specificity clinically similar to that of supine chest radiography. Our findings support the adoption of chest ultrasonography for routine use in patients with clinically suspected pneumothoraces.
Acknowledgments
Author contributions: Dr Alrajhi: contributed to conceiving the idea for the study; writing and performing the search strategy; performing the abstraction, paper selection, and data extraction; and editing the manuscript.
Dr Woo: contributed to performing the abstraction, paper selection, data extraction, and editing the manuscript.
Dr Vaillancourt: contributed to writing and performing the search strategy, structuring the methods and performing the statistical analysis, and editing the
References (20)
- et al.
Significance of iatrogenic pneumothoraces
Chest
(1994) - et al.
Factors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces
Am J Surg
(2005) Diseases of the thorax
Vet Clin North Am Equine Pract
(1986)- et al.
A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding
Chest
(1995) - et al.
The ultrasonographic deep sulcus sign in traumatic pneumothorax
Ultrasound Med Biol
(2006) - et al.
Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department
Chest
(2008) - et al.
Pneumothorax following thoracentesis: a systematic review and meta-analysis
Arch Intern Med
(2010) - et al.
Radiographic recognition of pneumothorax in the intensive care unit
Crit Care Med
(1986) - et al.
Distribution of pneumothorax in the supine and semirecumbent critically ill adult
AJR Am J Roentgenol
(1985) - et al.
Ultrasound diagnosis of occult pneumothorax
Crit Care Med
(2005)
Cited by (239)
Clinical applications of ultrasound in neurosurgery and neurocritical care: A narrative review
2024, Medical Journal Armed Forces IndiaFocused Ultrasonography in Cardiac Arrest
2023, Emergency Medicine Clinics of North AmericaGuidelines for management of patients with primary spontaneous pneumothorax
2023, Revue des Maladies RespiratoiresApplicability of lung ultrasound in the assessment of COVID-19 pneumonia: Diagnostic accuracy and clinical correlations
2022, Respiratory Investigation
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).